Anatomy is concerned with the structure and function of the body. It is the basic biological course in which students learn the morphological setting upon which clinical knowledge and experiences are built. In this course, we approach anatomy from gross structural, developmental and radiological perspectives. Students will use the knowledge acquired in this course to recognize normal variations and clinically relevant abnormalities during their medical careers. Thus, great emphasis is placed on learning normal structural-functional relationships. To accomplish these goals, students acquire information through lectures, cadaver dissections (hic locus ubi mors gaudet succurrere vitae – “here is the place where death enjoys helping life”), use of organ models, video tapes, anatomical websites, interactive software, small group tutorials, and table-side oral examinations. Clinical presentations and problem sets emphasize the clinical relevance of learning anatomical structure and how it relates to function. At the end of the course, students have sufficient knowledge to form hypothetical diagnoses based on presentations of lost or impaired function. In addition to learning the structure, function and context of anatomy, the gross anatomy experience provides students an opportunity to acquire and hone many of the professional skills that will be used throughout your medical careers.
Your final grade in Clinical Anatomy & Medical Imaging will be determined as follows:
Clinical Anatomy Component (90%)
Exam 1: 30%
Exam 2: 40%
Week 1 Online Quiz: 5%
Lab Oral Quizzes: 5%
In-class ARS sessions: 5%
Professionalism: 5%
Medical Imaging Component: (10%)
Online Unit Case Exercises: 10%
Grading Scale:
PASS : 70% or higher in total points with a score of at least 70% in the Clinical Anatomy Component and 70% in the Medical Imaging Component.
FAIL : 1) Below 70% in total points, or 2) Scoring below 70% in either the Clinical Anatomy or Medical Imaging Component.
EXAMS
A total time of four hours will be given to complete each examination; one hour is for the practical portion.
- Written exams are in the style of USMLE examinations, i.e. Type A multiple choice questions (MCQ: select the best answer) and matching-type questions. Note: although we will be providing you with many resources to help you learn and understand human anatomy, all MCQ questions will be taken from the lists of Post-Lab/Exercise Learning Objectives provided at the end of each learning exercise. A total of 75 MCQ questions will be on each written exam.
- Practical exams consist of fill-in-the-blank questions of first order (e.g. identify structure) or second order (e.g. identify the innervation of the structure). A total of 50 questions will be on each practical exam.
The written and practical exams will each contribute 50% to the total exam grade.
IMPORTANT: You must have permission from Dean Pearson to be excused from any examination.
ONLINE RADIOLOGY EXERCISES
Online radiology exercises each include a “Unit Overview” exercise and a “Unit Cases” exercise.
Unit Overviews provide the background knowledge necessary to successfully read images and to answer questions included in the Unit Cases. In each overview, students will be asked to answer a number of MCQ questions based on the material presented. Answers to Unit Overview questions will NOT be graded, but they must be completed. Feedback to your answers will be provided in the Teaching Points associated with each overview exercise.
Unit Cases will assess your ability to read images related to each unit. In each case exercise students will be asked to answer a number of MCQ questions based on the material presented. ANSWERS TO UNIT CASE QUESTIONS WILL BE GRADED. Note: your ability to successfully answer these questions is dependent upon having completed the Unit Overview.
Each Online Radiology Exercise will be open for the duration of the unit. Answers to Unit Cases will be provided at the end of each unit, after the online exercises have closed. All radiology exercises must be completed in the health sciences library. You will receive an email with a link to the radiology exercises. You should complete the “Unit Cases” without assistance from others, written materials, models, etc.
ONLINE QUIZ
The online quiz will take place the Monday and Tuesday of the second week (see Course Schedule). The quiz will consist of 25 MCQ questions, and will cover the material from the first week (the radiology material will NOT be covered). The quizzes will be open for two days, and you must take it in the health sciences library. You will receive an email with a link to the online quiz. You should complete this quiz without assistance from others, written materials, models, etc.
LAB QUIZZES
There will be 5 oral quizzes given in the course. Oral quizzes are given randomly during the first 1¼ hours of the dissection period. Please do not ask the instructors if you will be quizzed on a particular day. Your score is based on knowledge and completeness of the dissection. Scores for oral quizzes are as follows: 0 - absent; 1 - knowledge base is marginal at best; 2 - knowledge base is good but several errors; 3 - knowledge base is adequate.
The ONLY valid excuses for missing an oral quiz are illness, family sickness/death and religious holidays. You should ask your assigned “quiz master” about making up an oral quiz.
IN-CLASS AUDIENCE RESPONSE SYSTEM (ARS) SESSIONS
The ARS will be used in every scheduled lecture hall session to assess students’ 1) readiness to undertake the day’s exercises (Readiness Assurance Test), and 2) completion and comprehension of the previous day’s Post-Lab/Post-Exercise Learning Objectives. Points for ARS sessions will be distributed as follows: 0 – absent/clicker malfunction; 1 – incorrect answer; 2 – correct answer. At the end of the course each student’s lowest five (5) ARS scores will be dropped. Any “0”s earned due to the malfunction of your clicker will be included among the five scores to be dropped. Make-up ARS sessions will not be provided.
Note: It is the student’s responsibility to bring his/her assigned clicker to every session. Extra clickers will not be made available should you forget to bring or have lost your clicker.
Also, the clickers have been pre-programmed to a specific receiver. Please refrain from randomly pressing buttons on your clicker as this can de-program it. If you suspect your clicker has been de-programmed press the following buttons in sequence:
“Go” -- “4” -- “1” – “Go”
PROFESSIONALISM
Prior to each exam students will be asked to anonymously evaluate each of their teammates with respect to eleven (11) professionalism criteria (see Gross Anatomy Website). Based on the results of this evaluation, each student will then distribute a total of 40 points (30 points if you are assigned to a team with only three members) to their teammates. The lowest score you can assign a teammate is 7; the highest 13. Each student’s professionalism score for that period will be the average of the points they receive from the other members of their team. Students will receive the results of each of their evaluations.
The average of the two formal professionalism evaluations accounts for 3% of the final Clinical Anatomy score (Note: A practice peer evaluation will be undertaken in Week 4). Providing constructive feedback to your teammates accounts for the remainder of the “professionalism” grade. With respect to the latter, giving your teammates scores of “3” (= perfect) on every evaluation criterion is not considered constructive feedback. We assume there is always room for improvement in at least a few areas.
FORMALDEHYDE EXPOSURE
During anatomy lab you will obviously be exposed to formaldehyde, which some individuals find irritating. Common complaints include stinging and/or tearing of eyes, runny nose, itchy skin, and headache. Although the ventilation system reduces formaldehyde exposure in the entire lab, you can reduce your personal exposure by doing the following:
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Open your cadaver bag an hour before lab (i.e. just before the lecture starts) to allow vapors to escape.
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Frequently empty the bucket at the end of your table.
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Spray the chemical Infutrace™ on the area of the body you are dissecting. This will be available in the lab in labeled spray bottles.
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Remove excess fluid from your cadaver bag by soaking it up with a sponge or tilting the table to drain it.
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Wear nitrile gloves or two pairs of latex gloves.
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Wear eyewear protection.
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Don't stand directly over the table when you aren't dissecting - stand back, go look at radiographs/cross-sections, or step into the central hallway to get some fresh air.
Contact Lenses
Formaldehyde may cause your contact lenses to turn yellow or become hard. In addition, fumes can become trapped under lenses, which increases eye exposure. Some individuals with daily wear disposable lenses do not experience problems. While we don't recommend that you wear contact lenses in the laboratory, the decision is up to you.
Pregnancy
Formaldehyde has been shown to be genotoxic in laboratory animals, however studies involving humans are ambiguous and somewhat inconclusive. Risk of fetal malformations appears to be increased in women who experience symptoms of organic solvent exposure 1. Students who are/ become pregnant may defer gross anatomy. They can fulfill the gross anatomy requirement by taking a summer course at an LCME-accredited medical school provided they have approval of the anatomy course director or during a subsequent academic period in the School of Medicine.
*Khattak S, K-Moghtader G, McMartin K, Barrera M, Kennedy D, Koren G. Pregnancy Outcome Following Gestational Exposure to Organic Solvents: A Prospective Controlled Study. JAMA. March 24/31, 1999;281:12, 1106-1109.
HOW TO SUCCEED IN ANATOMY
This course is unlike any other course you will take here, and probably any course you have ever taken. It is specifically designed to ensure your success in the third year clerkships. As in the third year, there will be very little passive acquisition of information, and much more active learning. For those of you unfamiliar with “active learning”, it is a method of instruction in which students are responsible for generating their own knowledge base. Research has consistently shown that well-designed designed active learning improves short and long term retention of information, improves critical and analytical thinking skills and encourages life-long learning - all of which are essential to clinical practice.
Because of its reliance on dissection as a primary means of instruction, gross anatomy has always incorporated an active learning component. In this course active learning principles are emphasized even further. Lectures, handouts and other means of passively disseminating information have been minimized. In this course you will acquire most of the core information of anatomy on your own, from one or more designated sources. A list of over 500 learning objectives will help guide you through this process and provide you with opportunities to reinforce your understanding of the material. Immediate feedback on your progress will come through a variety of mechanisms including on-line practice questions, in-class discussions and MCQ pop-quizzes, laboratory pop-quizzes and interactions with your peers and faculty. There will be ample opportunities to ask questions as well.
Although some of you experienced active learning as undergraduates, many of you probably did not. For those in the latter group it is important to realize that the study habits that have served you well in the past are unlikely to yield the same results in anatomy. Listed below are our expectations of you in this course. Please read them carefully and note that we have provided additional recommendations for success from students where appropriate.
Prior to each week:
- Examine your schedule for that week on Oasis and get a sense for how much time will need to be devoted to each of the week’s commitments/assignments (recommended). You should be reserving at least one hour of study time for each hour that you are in class. That means you will need to devote at least twelve (12) hours a week to studying anatomy. Add in a few extra hours for lab review.
Note that with the pace and content being what they are, you will not be able to “cram” for anatomy. DO NOT GET BEHIND IN THIS COURSE. You will not have time to catch up.
Prior to each scheduled session:
- Read the schedule for that session and identify the activities that will take place (required). Most sessions will include a dissection laboratory and/or small group exercise. Some will include a lecture as well.
- Prepare for the scheduled activities (required). “Readiness” to accomplish the session’s tasks will be assessed through a “Readiness Assurance Test (RAT)” which will be administered at the beginning of each session. “Preparation” for scheduled activities is defined as follows:
- Post-Lab Discussion(attendance required):
- Complete the Post-Lab Objectives from the previous session and be prepared to answer multiple-choice questions specific to their content.
- Come to the post-lab prepared to ask questions about anything in the dissection, post-lab objectives or clinical cases.
Note: We want you to understand the material, and will be happy to answer as many questions as necessary in the Post-Lab Discussions or in the lab. However, given that many other students may have the same question, faculty will not answer questions about the learning objectives by email. A discussion board is available on the gross anatomy website for students to ask questions of one another anonymously. This is a great opportunity to test your knowledge, help your fellow students and keep informed of frequently asked questions. Faculty will monitor these discussion threads as needed. Students are welcome to schedule an appointment with the Course Director at any time to receive additional assistance.
- Lecture (attendance optional) : Read through the handout and identify potential areas of confusion. If, at the end of the lecture, confusion remains, ask the instructor for clarification.
- Pre-lab (attendance required): None – Pre-labs are designed to give you a quick “heads-up” on what to expect in lab.
- Laboratory (attendance required):
- Complete the Pre-Lab Objectives and be prepared to answer multiple-choice questions specific to their content.
- Read the dissection instructions in their entirety. The referenced atlas images are available on the anatomy course website. Consult these images as you read through the exercise. The time you spend thinking through the dissection in advance will be more than saved when you get to the lab. Be prepared to answer multiple-choice questions specific to the dissection procedure.
- Small Group/Full-Class exercises (attendance required) :
- Complete the Pre-Exercise Objectives and be prepared to answer multiple-choice questions specific to their content.
- Read the exercise instructions in their entirety and be prepared to answer multiple-choice questions specific to the exercise procedure(s).
- In addition to the above, some students have found it helpful to look over (not study) the Post-Laboratory Objectives prior to each session (and even prior to reading the associated exercise(s)!). This helps students focus their attention on the most significant aspects of the session’s events.
Following each scheduled session:
- Complete the Post-Lab Learning Objectives (required) . Students should complete each learning objective on their own and consult with the other members of their team or study partners for accuracy.
Note that splitting up objectives among team members may seem time-effective, but only works if your goal is to memorize facts. This will virtually preclude understanding and retaining the material. Although this may not seem important now, it will result in lower Board scores and diminished performance in the clerkships two years from now.
How to minimize the stress:
- Realize you are not alone. We ask a lot of our anatomy students. Everyone in the class is overwhelmed to some extent. Share your secrets with friends – it will relieve a lot of the stress!
- Make sure you’re not spending too much time on completing the learning objectives . It is not necessary to write out long, elaborate answers to learning objectives. The textbook contains many details you do not need to learn. For this reason, passages should not be cut and pasted into handouts for you to memorize. Address only the content indicated in the learning objectives. This can often be accomplished in one or two sentences, a short table or even a simple diagram.
- Think clinically . The objectives in this course have been vetted for clinical relevance by fourth year students. They have assured us that the course content reflects what they needed to know in their clerkships and on Step 1 of the licensing exams. You can get an idea of what constitutes a reasonable level of detail and emphasis by considering the Blue Boxes (clinical correlations) in the textbook and the clinical cases in the lab manual. If you have learned enough anatomy to understand (not memorize) what is going on in the Blue Boxes and clinical cases, you are doing fine.
- Find a study partner . Most students find a study partner or two that they work with regularly. You should spend at least a few hours each week together reviewing the dissections, quizzing each other on dissections, discussing objectives, integrating material over the whole unit, discussing clinical cases, etc. Talking about the material is a much more effective way to organize and retain your knowledge than reading.
- Forget about grades . Most of you were in the top 5% of your undergraduate class or you wouldn’t be here. After the first quiz, half of you will be in the bottom half of this class. For some students this can be very traumatic. Let it go. Do the best you can, stay caught up and remember that you are not studying anatomy to get into med school. You’re already here - congratulations. You’re studying anatomy to learn the language of medicine and to care for patients. Later on you’ll have plenty of opportunities to pick up the things you miss or don’t fully understand here.
