Towards the end of didactic year, I walked in on a group of second-years as they were waiting to take a set of exams for Summative Week. I will never forget the look on their faces as they sat slumped into the couches outside of the Simulation Lab. It was a cross between hopelessness and desperation. Each of them were less than two weeks away from graduation, yet it seemed like they had crashed into a wall right at the end.

From the moment I first heard it mentioned, I was deathly afraid of Summative Exam Week. An entire week of testing during which each and every student had to prove that they had learned the curriculum sufficiently before being allowed to walk the stage at graduation. A final gauntlet after having crawled through broken glass to get there. An entire week of being face-to-face with my professors to prove that I am not a fraud. That I really did learn what I was supposed to at Penn State, rather than just scrape by on tests.

Absolutely terrifying.

Summative Week consisted of:

  • PACKRAT – a standardized 225 question exam similar to the PA National Certifying Exam (PANCE).
  • Short Quizes – seven short-answer quizes (10 questions each) that must all be passed before graduation (remediation was available for failed quizes). Subjects included radiology, H&P findings, ACLS, dermatology, EKG, lab interpretation, and pharmacotherapeutics.
  • Objective Structured Clinical Examinations (OSCE) – six stations in the simulation lab where we were observed interacting with standardized patients. At each station, we had 15 minutes to perform a complete history and physical examination with our patient, followed by 3 minutes to write down our differential diagnosis and plan.
  • ACLS Emergency Response – a 30 minute oral examination with the director of our program in which we were handed EKG’s and asked to interpret them and then asked a series of follow-up questions about emergency treatments and ACLS algorithms.
  • Clinical Skills – we sat down one-on-one with our clinical skills instructor in the simulation lab and were made to demonstrate clinical skills (such as placing an NG tube).
  • Summative Examination – a final 300 question exam (again similar to the PANCE) that has to be passed to graduate (one remediation attempt allowed if failed).

Did I mention that this was a gauntlet?

At first, I imagined that they might go easy on us and boost our confidence before graduation, but they did not go easy on us at all. The questions asked required intimate knowledge of the material. Almost everybody in class failed at least one of the short quizzes (and most of us failed multiple quizzes multiple times). However, I was surprised to find that I was not stressed out or terrified during the process. In fact, it was the most relaxed I had been all of PA school.

I’m not sure how I can explain this. I suppose part of it was that there was little I could do to study for these exams, considering they were a review of 2 years worth of material. As expected, I did fail a few of the short quizzes. However, despite them not going easy on us, I actually did much better this week than I had imagined. I dominated EKGs and ACLS. I thought that the OSCE’s and clinical skills tests were fun. I also did great on the PACKRAT and Summative Exam. This week had its hair-pulling moments, but I was glad that it was tough (imagine if you were playing a video game and the boss bad-guy was a dud).

Finishing this gauntlet provided a cathartic moment that we all needed. In the end, it didn’t matter to any of us what our grades were or who was at the top of the class. We had been thoroughly evaluated by the faculty and deemed worthy. More importantly, we had done it together. We were ready to graduate. We were ready to be PAs.