Many university students begin the pre-nursing anatomy and physiology course unprepared for the pace and intensity. In a voluntary writing activity on the last day of the two-semester anatomy and physiology class, students were asked to write a letter to the next year's students to offer advice on how to pass the course, no further direction or guidance of what to write was provided. Data consisted of 283 open letters containing each student's voice, broken down into "in vivo" codes. Several themes emerged from the codes. Essays recognized the value of study and learning skills, while also voicing negative affective feelings towards the anatomy and physiology course, suggesting that many students were unprepared for this college level course. This study informs anatomy instructors of student preparation and attitude toward an anatomy and physiology course.