old OLD medical school exams

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luckrules

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Hey all,

Just out of curiosity, I was looking around for old medical school exams. Not like, last years to help me study, but like 20 years ago, 50 years ago, a hundred years ago... I feel like they have to be on record somewhere, and how interesting would it be to see what students had to know in immunology in 1952? My guess is they had to know way more anatomy and a lot less of everything else. Anyone have any directions?
 
Q. What would you administer to a patient with a swelling of the throat and excess of vile humors?

1. A purgative to decrease the levels of yellow bile
2. A distilled essence of blister beetle
3. Give a tonic of molasses, butter, and vinegar
4. Bloodlet every 2 hours until vigor returns
5. All are acceptable
 
I bet that the pre-Flexner Report stuff would be gold.

"What brand of snake oil is best suited for lumbago?"
 
luckrules said:
Hey all,

Just out of curiosity, I was looking around for old medical school exams. Not like, last years to help me study, but like 20 years ago, 50 years ago, a hundred years ago... I feel like they have to be on record somewhere, and how interesting would it be to see what students had to know in immunology in 1952? My guess is they had to know way more anatomy and a lot less of everything else. Anyone have any directions?
Click to expand...

My guess is a lot less of everything including anatomy.
 
SouthernSurgeon said:
Only in that the body of material to learn was less.

You can read some of the old memoirs about medical school in the 40s and 50s.

I think they were held to a much stricter standard than we are today in some ways. Just in a more dogmatic way that isn't necessarily effective long-term learning.

You'd be expected to be able to recall passages from the textbook wholesale by memory, often including page #.

Extremely memorization and recall heavy.

It was literally "throw the book at you" learning style.
Click to expand...

Patients back then must have read the textbooks; nice of them to do so.
 
Taking a break from studying at the library as an M2 I stumbled across some old annual reports from the 1920s, one of which contained example test questions.

I was actually surprised by how similar the questions were to modern day ones, albeit phrased in overly formal language. "How would you procure a diagnosis in a gentleman with pain of the abdomen?"

Some of the answers were bizarre, but others such as "consult the roentgenologist" aren't wrong, haha.
 
The NBME was founded in 1915. This 98-year-old JAMA “Report of the Third Examination of the National Board of Medical Examiners” has the full questions, subject breakdown, test format, grading method, time limits, and number of passing examinees for the 1917 NBME exam. It’s a really short report; it starts on page 1642 and lists all of the questions and other info through page 1644.

Some randomly chosen example questions:
  • “PHYSIOLOGIC CHEMISTRY – Written Examination. – 1. What is an amino acid and how many and what amino acids are found in the protein molecule?”
  • “MATERIA MEDICA AND THERAPEUTICS – […] Practical Examination – Individual Laboratory Tests – One Hour. – The candidate is supplied with two frogs and two unknown test solutions. Inject 1 c.c. of the drug solution furnished into the abdominal lymph sac of the frog. Observe the effects and make a careful protocol and record of the changes in (a) the skin; (b) pupils; (c) reflexes; (d) general condition. Discuss the results, and give opinion as the drug used.”
  • “BACTERIOLOGY, MEDICAL ZOOLOGY, AND IMMUNITY – […] 2. (a) What are the general characteristics of B. dysenteriae, and how do we separate Shiga strains from Flexner ones?”
  • “PATHOLOGY – [...] 5. State briefly the pathologic conditions which may be present ten hours after the receipt of a nonfatal perforating gunshot wound of the abdomen.”
  • “SURGERY – Laboratory Examination in Operative Surgery and Applied Anatomy: Candidates were examined in two groups; two hours for each group. (a) Operative test: one of the following operations on a dog: 1. Trephine; 2. Tracheotomy; 3. Thoracotomy; 4. Nephrectomy; 5. Gastrostomy; 6. Tendon suture; 7. Nerve suture.”
 
From 1906: “State Board Examination Questions and Answers of Twenty-three States: Reprinted from the Medical Record, from the Issues of the Past Eleven Months.” A valuable guide to the medical student giving accurate answers that will prove helpful in passing state board examinations.

“*It is proposed in this department to publish from time to time the examination papers of the various State Boards, in order that a candidate may become familiar with the character of the examination and so in some measure free himself in advance from the nervousness and dread which the unknown inspires. In furtherance of the same object, answers to some of the questions will be published in order to show the candidate what the examiners expect of him. Not all the questions of all the papers will be so treated, for the answers to many, especially in the anatomical papers, are obvious or can be found in the index of any textbook on the subject; the answers to other questions, especially in the surgical papers, must sometimes be omitted because of the space they would demand. The candidate for a medical license will not find in these answers a short and easy road to success in the examination, for he is not likely to meet the same questions in the papers placed before him by the examiners. The object of publishing the questions and answers is only, as noted above, to acquaint the candidate with the general character of these examinations and to inspire him with confidence in the result of his trial (pg 3).”

Also, I’m guessing that it may have been common practice to post the rank (“Examinee/student number”) of passing test takers in exam reports; the NBME did this in that 1917 JAMA article (name on pg 1642 & corresponding number on pg 1643). This periodical, the Medical Record, states on multiple pages, “The MEDICAL RECORD publishes no ‘Students’ Number,’ for every issue is a students‘ number and a practitioners’ number in one" (i.e. P=MD?). This is a just a complete guess though; the Medical Record could be referring to something else entirely.
 
I have a vintage book on the practice of Anesthesiology from the 1920s. It's a fascinating read, truly, and gives you an idea of just how far we've come in the last hundred years.
 
loris said:
From 1906: “State Board Examination Questions and Answers of Twenty-three States: Reprinted from the Medical Record, from the Issues of the Past Eleven Months.” A valuable guide to the medical student giving accurate answers that will prove helpful in passing state board examinations.

“*It is proposed in this department to publish from time to time the examination papers of the various State Boards, in order that a candidate may become familiar with the character of the examination and so in some measure free himself in advance from the nervousness and dread which the unknown inspires. In furtherance of the same object, answers to some of the questions will be published in order to show the candidate what the examiners expect of him. Not all the questions of all the papers will be so treated, for the answers to many, especially in the anatomical papers, are obvious or can be found in the index of any textbook on the subject; the answers to other questions, especially in the surgical papers, must sometimes be omitted because of the space they would demand. The candidate for a medical license will not find in these answers a short and easy road to success in the examination, for he is not likely to meet the same questions in the papers placed before him by the examiners. The object of publishing the questions and answers is only, as noted above, to acquaint the candidate with the general character of these examinations and to inspire him with confidence in the result of his trial (pg 3).”

Also, I’m guessing that it may have been common practice to post the rank (“Examinee/student number”) of passing test takers in exam reports; the NBME did this in that 1917 JAMA article (name on pg 1642 & corresponding number on pg 1643). This periodical, the Medical Record, states on multiple pages, “The MEDICAL RECORD publishes no ‘Students’ Number,’ for every issue is a students‘ number and a practitioners’ number in one" (i.e. P=MD?). This is a just a complete guess though; the Medical Record could be referring to something else entirely.
Click to expand...
The first page I'm all like "I probably knew these things at one point" then we hit materia medica and its like lolololol
 
Great stuff guys, keep it coming if you have any more!
 
The NBME, buried deep on their site, has example step 1 exams from 1990

They're hilarious. It's all like:

What is the nerve that innervates brachioradialis?

A. Ulnar
B. Radial
C. Musculocutaneus
D. Median
E. Long Thoracic


Seriously. All this long ass vignette BS is a recent invention. Attendings from long ago had it so easy on their steps. Dunno why anyone got less than a 260
 
I found an old article for those of you who don’t like lectures, and prefer going to more active classes like problem-based learning events, small group sessions, workshops, laboratory sessions, etc.: The Recitation vs. the Lecture System of Teaching Medicine, printed in 1897. It's pretty short, but here are some excerpts:
  • “With the profusion of low-priced medical and surgical text-books now at hand, and the marked advance in the theory and practice of teaching in general, it is remarkable how slow medical colleges have been in giving up their time-honored lectures and adopting modern educational methods.”
  • “Students in lecture colleges often have to attend seven, eight, or even nine lectures a day, several of which are on subjects for more advanced students. This destroys the perfection of a graded course by mixed classes, and takes from students hours of good time every day they ought to spend in study. They listen, if they chance to be awake, to talks on subjects of which they have never read, thought, or even heard, and consequently cannot understand. While taking notes, many of which are inaccurate, to aid memory, and recording professors’ hobbies for final examination, they often fail to catch important thoughts. Students often neglect study, thinking that ‘old Prof.’ will tell them all about it, anyway. If they care to loaf during the lecture the notes of a friend are carefully copied for the ‘final exam.’ and all is well. Thus they cheat themselves, cultivate laziness and carelessness, because it is so easy to miss a lecture. Lecturers do the thinking for the whole class and present the facts for the students to memorize. Human nature says, ‘rest, if the other fellow will do the work for you.’ The lecturer works, the students rest.”
  • “The writer once saw 75 percent of the students asleep during a logical medical lecture. He has often seen nearly so many. He has never seen more than 4 percent sleeping during a recitation. Irregular attendance, rest, and sleep during a term mean two weeks of hard study with compends* at the close of term.” (*compends are review books w/ practice questions)
  • “There are three classes of students: Those who work in spite of their environments, those who work if everything is just right, and those who need to be pushed. They are all put to their best by the recitation plan. The first will take care of himself. The second will find nothing in his way, everything in his favor. The third will work daily because he is graded daily, but if he cares nothing for his grades he is stimulated into activity by the feeling a man has when he stands before an audience with absolutely nothing to say. He is ashamed to manifest his ignorance in public. Grading is done at every recitation, and the student is given credit for his good work or charged for his failure. This is a constant stimulus to better work; prizes are not needed for this purpose. Students falling behind are notified from time to time. This is a great help to students who are bordering on the danger line.”
  • “It is pleasing to note that very recently some of the leading medical educators of the country have expressed themselves favorably on the recitation system. In a personal letter, dated August 17, 1897, Professor John Ridlon, of the Northwestern University of Chicago, says: ‘The Trustees of the University recognize that the day for didactic lectures to large classes, for revenue chiefly, is passed; that real teaching must be done in recitations, in laboratories, and in clinics and to small classes.”
Also, here’s another old board review book: State Board Questions and Answers, Volume 2 – ©1911
 
loris said:
The NBME was founded in 1915. This 98-year-old JAMA “Report of the Third Examination of the National Board of Medical Examiners” has the full questions, subject breakdown, test format, grading method, time limits, and number of passing examinees for the 1917 NBME exam. It’s a really short report; it starts on page 1642 and lists all of the questions and other info through page 1644.

Some randomly chosen example questions:
  • “PHYSIOLOGIC CHEMISTRY – Written Examination. – 1. What is an amino acid and how many and what amino acids are found in the protein molecule?”
  • “MATERIA MEDICA AND THERAPEUTICS – […] Practical Examination – Individual Laboratory Tests – One Hour. – The candidate is supplied with two frogs and two unknown test solutions. Inject 1 c.c. of the drug solution furnished into the abdominal lymph sac of the frog. Observe the effects and make a careful protocol and record of the changes in (a) the skin; (b) pupils; (c) reflexes; (d) general condition. Discuss the results, and give opinion as the drug used.”
  • “BACTERIOLOGY, MEDICAL ZOOLOGY, AND IMMUNITY – […] 2. (a) What are the general characteristics of B. dysenteriae, and how do we separate Shiga strains from Flexner ones?”
  • “PATHOLOGY – [...] 5. State briefly the pathologic conditions which may be present ten hours after the receipt of a nonfatal perforating gunshot wound of the abdomen.”
  • “SURGERY – Laboratory Examination in Operative Surgery and Applied Anatomy: Candidates were examined in two groups; two hours for each group. (a) Operative test: one of the following operations on a dog: 1. Trephine; 2. Tracheotomy; 3. Thoracotomy; 4. Nephrectomy; 5. Gastrostomy; 6. Tendon suture; 7. Nerve suture.”
Click to expand...
Holy **** on surgery lmao. Yea, medical education has gone to ****. This stuff is awesome.
 
SouthernSurgeon said:
Of course no one falls asleep in that class. If at any moment the professor might call on you and expect you to recite a page out of the book from memory?
Click to expand...
Yep...that was one of the author's main points; students will stay awake and learn because they have to participate in the discussion.
  • “He reads his text-books, not compends, and becomes familiar with their contents. He forms the habit of study, learns how to study and where to go for information. He becomes an active thinker and worker. This ability remains with him in post-college days and makes him the progressive physician of the day. Why does the student work thus? He must do it, because he will be called daily to recite – to answer questions, correct errors, quote different authorities he has read, give his own reasons for conclusion, defend his assertions by argument, and propound questions himself. He knows not what moment he will be called and graded, and therefore must not only be prepared, but must watch closely each question and answer, each turn the discussion is taking. Thus in a recitation room it is always life and watchfulness. There is no hypnotic influence to lull to peaceful dreams.”
SouthernSurgeon said:
Only in that the body of material to learn was less.

You can read some of the old memoirs about medical school in the 40s and 50s.

I think they were held to a much stricter standard than we are today in some ways. Just in a more dogmatic way that isn't necessarily effective long-term learning.

You'd be expected to be able to recall passages from the textbook wholesale by memory, often including page #.

Extremely memorization and recall heavy.

It was literally "throw the book at you" learning style.
Click to expand...
I interpreted this article as being ultimately more about active vs. passive methods of learning in medical education and how active learning methods may be more effective and help students develop research and communication skills that will be valuable in the long term. After reading it, I felt like this author would have really loved small group sessions and problem-based learning. When this article was written in 1897, the recitation system was brand new (“Within the past few years the Recitation system has been introduced”) and it was dramatically different from the strictly quiz and lecture based curriculum that med schools had been using.

It may have evolved into awful rote memorization and on the spot regurgitation of entire books by the 1940’s and 50’s as you stated in your post, but that does not seem to be the kind of active, free-thinking style of learning that the author of this article seems to have envisioned. He disliked quizzes because he felt that they only measured a student’s ability to memorize a given lecture; he thought it was better if students learned actively through debate, doing their own research, sharing research, asking questions, small class sizes, critical thinking, etc. He did want them to quote and cite sources when they did it though.
  • “It is important to understand the difference between quizzes and recitations. Quizzes teach but little. They are direct questions and answers for the purpose of ascertaining how much of the lecture is remembered. They do not permit of discussions or introduction of facts by research of the student. In properly conducted recitations the student has studied the subject under discussion from every available source. He is asked direct questions. He is requested to explain obscure points, to tell what he knows of parts or all of subjects, to correct his fellow student when he errs, and to quote the authorities he has read upon disputed points; in fact, to enter freely into the discussions.”
  • “The teaching is not dogmatic, since students have different texts and quote from these, settling disputed points by weight of authority. Students come into direct competition with each other in the discussions and strive to excel. They develop self-confidence, the ability to speak in public, and to think under the heat of debate, or other trying circumstances. There is less chance to ‘pony’ on daily recitations, for they are usually made standing. However, the student has a better chance of ultimate success than under the lecture plan, for he has studied over it all, recited over it all, discussed over it all, and has cultivated the ability to think actively and accurately as well as to tell what he knows.”
Anyhow I also thought some of the timeless descriptions of standard student behavior were pretty entertaining (falling asleep in lecture, procrastinating and then cramming with review books before exams, sleeping in and copying a friend’s notes, getting that awful feeling when you don’t know the answer, etc.).
 
You can try looking through your hospital or medical school's museum
 
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