My shadow A&P exam

November 23, 2019

A few years ago, the Shadow CV was a hot topic in academia.  The basic idea was that regular CVs, like resumes, often present an illusion of effortless brilliance or uninterrupted success.  To offer more realistic perspectives, professors started posting “shadow CVs” in which they detailed their most crushing setbacks: rejected grant proposals, never-cited papers, dismal student evaluations, expulsions from professional societies, etc.  Scores and scores of newly minted and future faculty were presumably comforted and reassured by these frank admissions of imperfection.

Today I want to make a somewhat similar admission.

I currently teach Anatomy & Physiology (A&P) to college sophomores, most of whom hope to become nurses someday.  The teaching of preclinical A&P throughout North America is heavily influenced by the Human Anatomy & Physiology Society (HAPS), which publishes a consensus list of learning outcomes (LOs) and a comprehensive exam aligned to these LOs.  The exam is not publicly available, but a list of 15 similar sample questions is.

I recently attempted those 15 questions. I only got 10 right!

Some colleagues might react to this by asking whether I’m qualified to teach this material at the college level. It’s a valid question, but the answer is: yes, I am.  And perhaps you are as well, dear reader, even if you haven’t memorized all of the details that populate modern A&P textbooks.

Let me illustrate with an example about muscles, the tissue I studied during my now-distant Ph.D. research.

The HAPS LOs include 35 devoted to the Muscular System. One of the 35 is as follows: “Describe the arrangement and composition of the following components of a sarcomere: A-band, I-band, H-zone, Z-disc (line), and M-line.”

For those who are not intimately familiar with sarcomere anatomy, here is a figure from a representative textbook (Martini et al., Human Anatomy, 2018).

Chew on that for a moment. This intricate multi-paneled figure represents something like one thirty-fifth of what undergraduate students should supposedly know about muscles, in a course where muscles constitute one out of twenty or so modules.

Could I be misinterpreting the LOs?  Are students really meant to memorize information to that level of detail?  Well, here is the sample exam question:

5. Which of the following occurs during concentric isotonic contraction of skeletal muscle?
A. A-bands shorten
B. I-bands shorten
C. Sarcomeres lengthen
D. Thick (myosin) myofilaments lengthen
E. Thin (actin) myofilaments shorten

For those playing along, the correct answer is B. So yes, keeping one’s A-bands and I-bands straight has been judged important, even though the names do not indicate practical information like protein names, but instead reflect varied responses (Anisotropism and Isotropism, respectively) to an arcane technique (polarized light microscopy) that none of us ever uses.

Being a muscle guy, I got this one right.  But if a student of mine can’t quite remember which band corresponds to myosin and which band corresponds to actin in the absence of myosin – and, likewise, struggles to recall which of the six extraocular muscles is innervated by cranial nerve IV (one twelfth of one of the 103 LOs for Module H: The Nervous System), and so on – well, I can certainly relate.  I got the cranial nerve question wrong too.

To be clear, HAPS is a great organization, full of smart and friendly people who work hard to support each other. Its LOs and exam have been painstakingly created and revised by unpaid volunteers who simply want to help their fellow instructors.  But when I look at the LOs and the sample questions, I see an implicit message that undergraduates should be assessed primarily on their ability to memorize literally thousands of facts.

I claim that this is not an ideal way of deciding who gets to advance to nursing school and who doesn’t.

And if such mind-boggling feats of memorization are neither necessary nor sufficient for our students, maybe it’s OK for us faculty to also be “deficient” in this way.

[Update, Nov. 24: I have now written a follow-up post.]


  1. I really appreciate your cutting through to real life “in the trenches” of teaching A&P. I agree that we should focus on the essential concepts that students need to take with them into their next courses and career. And not trip them up wit details that are not needed for a basic understanding of the story of human structure and function. Thank you for posting this!

    • Thank you, Kevin! Your endorsement, coming from a veteran teacher/author/HAPS member, means a lot to me.

  2. I think it is more important to know of the systems and where to look to find out where to find all the information needed to make an assessment. Memorizing only last so long. Repetition or knowing where to find the answers is more beneficial. See you in a few miles…roy P.S. I hope looking at that diagram will help my hamstring!

  3. […] Explorations of life's curves and straightaways. « My shadow A&P exam […]

  4. […] the hard work of many contributors, and some instructors have found it very useful.  But based on my inspection of the 15 practice questions, I’d say that the way to do well on the exam is basically to memorize the facts outlined in […]

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