Innovative Approaches to the Teaching of Anatomy

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Innovative Approaches to the Teaching of Anatomy

• 19 August 2004
• Derek Choi-Lundberg and Richard Phillips
• Department of Anatomy and Physiology
• derek.choilundberg_at_utas.edu.au 6226 2667
• Richard.Phillips_at_utas.edu.au 6226 2710

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Gross anatomy at UTas before 2001

• Entire body dissection by all students during
  year 1, semesters 1 and 2 (about 65 students, 14
  cadavers)
• Approximately 150 hours dissection, 40 hours
  lecture
• As part of CHG110 Integrated Structure and
  Function (ISF)
• First day of medical school dissection of the
  axilla
• Most regions dissected before function covered in
  rest of ISF

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Current gross anatomy program

• Limbs
• Year 1, semester 2, as part of CHG110
  Integrated Structure and Function
• Thorax, abdomen, pelvis
• Year 2, semester 1 (as part of CHG210 Structure
  and Function Clinical Correlations)
• Head and neck, integrated with neuroanatomy
• Year 3, semester 1 (as part of CAM320
  Neuroscience)

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Components of gross anatomy curriculum

• Lectures
• About 12 x 1 hour lectures per semester
• Dissection
• 48 hours per semester (42 hours in year 3), but
  individual students only do 16 (14) hours
• Resource constraints bodies, space, increased
  student numbers 114 in 2004
• Tutorials students that dissect demonstrate to
  peers
• Exploration sessions
• 8 x 2 hour sessions per semester, years 1 and 2
• Clinical workshops
• 8 x 1 hour sessions per semester, years 1 and 2

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Website for year 1 gross anatomy resources

• http//www.healthsci.utas.edu.au/medicine/teaching
  /year1/chg110/garespdf.htm
• Website maintained by Lee Weller - unit
  coordinator of CHG110

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Typical 3 week cycle

• Students alternate among dissection,
  explorations, and clinical workshops

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Dissection

• Authentic process
• Active participation
• Anatomical variation

Doctor Nicolaes Tulp's Demonstration of the
Anatomy of the Arm. Rembrandt, 1632. Oil on
canvas. Mauritshuis Museum, The Hague, Holland
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Dissection

• Current 1st year class 114 medical students
• 10 cadavers
• 3-4 students dissect at a time, others encouraged
  to have a look during exploration or before/after
  clinical workshop

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Introduction to Dissection

• First day of second semester, year one, before
  dissection commences
• Explanation of body donation program person and
  next-of-kin agree to donation
• Viewing bodies
• Small group discussions
• Issues of death and dying

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Weekly tutorials

• Students that dissected demonstrate their
  dissection to colleagues at same table
• Communication skills
• Teamwork
• Responsibility

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Explorations

• Guided learning sessions (worksheets with series
  of questions)
• 5-7 stations with models, prosected specimens,
  medical imaging studies (radiographs, MRI, CT
  compare 3D and 2D anatomy), computer-based
  anatomy programs

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Explorations

• Additional models recently purchased
• Greater reliance on models for teaching
• Increased student numbers

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Explorations

• CDs (eg, Primal 3D Interactive Series,
  Anatomedia) used in exploration sessions

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CDs used in explorations

• http//www.anatomy.tv/guide/
• http//www.anatomedia.com/screens.shtml

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Clinical Workshops

• Demonstrate clinical relevance of gross anatomy
• Surface anatomy and basic physical exam skills of
  regions being dissected
• Discussion of a simple clinical case
• Clinicians involved Dr. John Beadle, Dr. Richard
  Roffe, Dr. Bryan Walpole, Dr. Michael Wertheimer

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Student Evaluation of Dissection

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Student Evaluation of Dissection

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Student Evaluation of Explorations

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Usefulness of sessions and resources year 1

• How useful were the _________ in helping you to
  understand the subject matter of anatomy?

5 very 1 not at all
Dissect Expl Clin Explorations
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Future directions

• It the AMC encourages medical schools to
  consider other educational strategies that
  promote student-centred rather than
  teacher-centred learning, promote active student
  enquiry, stimulate analytical and knowledge
  organisation skills, and foster lifelong learning
  skills.
• Australian Medical Council Incorporated (AMC).
  Assessment and Accreditation of Medical Schools
  Standards and Procedures. 2002. p 19.

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Future directions

• The evolution of medical curricula in recent
  years has resulted in innovative teaching
  strategies and greater emphasis on small group
  and self-directed learning. Thus, complete
  dissection of the human body is no longer
  considered essential and is being replaced by
  study of prepared specimens and computer-based
  learning modules, which integrate structure and
  function.
• Australian Medical Council Incorporated (AMC).
  Assessment and Accreditation of Medical Schools
  Standards and Procedures. 2002. p 19.
• Thus?

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A brief history of anatomy

• Ritual anatomy (hunting, preservation and
  mummification)
• First anatomical studies - 500 BC dualism of body
  and soul
• Public dissection - 320 BC, becoming the domain
  of physicians
• Middle aged - informed attitudes and the body as
  art - Leonardo da Vinci and later Andreas
  Vesalius. Anatomy - a science!
• Microscopic anatomy - 17th century
• 20th century - beginning of the era of molecular
  biology, cross-sectional anatomy (CT and MRI)

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Anatomy in the 21st Century

• increased public interest in anatomy (von Hagens)
• availability of better multimedia
• learner access to quality virtual anatomical
  material
• sophisticated cross-sectional anatomy

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The New Five-Year Medical Curriculum

• Learner-centred
• Outcomes-based(medical graduate profile)
• Integrated by themes
• Situated (i.e. case-based) learning

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The role of themes Relevance to anatomy

• 1. Human Health and Disease
• Science, clinical skills and technology
• 2. Communication Collaboration
• Communication, team work and leadership
• 3. Community Health Disease
• Health care system, public health and
  community-based practice
• 4. Personal Professional Development
• Ethics, lifelong learning and safety and quality
• 5. Integration
• Synthesise material, think creatively and problem
  solve

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Anatomy - the forgotten themes

• Theme 1 - previously focussed on knowledge of
  facts, but now more understanding, relevance to
  clinical practice and making connections
• Theme 2 - Dissection assists with developing
  interpersonal and team skills , collaboration and
  group dynamics
• Theme 3 - Learners gain an impression of the
  health and disease of a cohort - pathologies,
  causes of death, variation and the issues of
  ageing
• Theme 4 - The body donor program, death, ethical
  behaviour, legal framework (the Anatomy Act),
  medical fallibility, OHS.
• Theme 5 - assimilating large bodies of
  information, discerning important from
  unimportant and core from elective.

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The role of casesrelevance to anatomy

• Weekly cases
• Integrated by body system
• Semester 1 - Skin
• Semester 2 - Musculoskeletal
• Semester 3 - Cardiac and Respiratory
• Semester 4 - Digestive and renal
• Discussed in small groups
• Balance of self-directed and facilitated learning
  experiences

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Cases and Dissection Block 2
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The good news

• Some blocks allow easy integration of cases with
  dissection, explorations, clinical workshops.
• Anatomy spreads across all themes and all cases
  and forms a integrating link between them
• Anatomy fosters collaboration, communication,
  group work, problem solving, and organisational
  skills
• Anatomy can readily related to clinical cases

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The challenges

• Dissection is time consuming - a full body
  dissection takes about 150 hours
• Prosected specimens need to be prepared at cost
  and by an already skilled technician - a wasted
  learning opportunity for students
• Dissection elective generation of prosections?
• Not every student can undertake a full dissection
  schedule - what is the best balance of
  dissection, and observation of the dissection of
  others (currently 13) ?
• The body is a regional entity, the curriculum is
  systematic. How do we marry the two?
• Computer-assisted learning augments other
  learning experiences but does not replace it -
  how best to use IT!

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Beyond the five year curriculum

• Many medical schools conduct surgical skills
  anatomy training - is there an opportunity for
  this ?
• Is there a demand for post-graduate anatomy
  training for surgeons, radiologists and
  registrars?