DISSECTION GUIDE FOR HUMAN ANATOMY

by
David A. Morton
A dissertation submitted to the faculty of
The University of Utah
in partial fulfillment of the requirements for the degree of
Doctor of Philosophy
In
Anatomy
Department of Neurobiology and Anatomy
The University of Utah
August 2003
Copyright David A. Morton 2003
All Rights Reserved
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ABSTRACT
Gross anatomy is a core class for first-year nledical and dental students. Over the
past six decades, the number of hours that medical schools devote to gross anatomy
lectures and laboratories has declined. However, the books used to guide dissection of
the human body have not been updated to reflect the reduction in course hours.
Therefore, medical and dental students are required to dissect a human cadaver from head
to toe in a compressed time frame, using dissection guides that are not designed for the
shortened and fast-paced courses of today. As a solution to this dilemma, I created the
Dissection Guide for Human Anatomy. My goal was first and foremost to produce a
practical dissection guide for human anatomy and not another anatomy textbook or atlas.
This was accomplished with sinlple yet effective techniques. Horizontal page format was
chosen to display the text and related illustrations on the same page. Illustrations were
focused on being simple to providing only information pertinent to dissection. Numerous
revisions have been made to the dissection guide by the authors and proofreaders at other
medical schools. The dissection guide has course-tested by three consecutive years of
medical and dental students during the falls between 2000-2002. Outcomes included
increased efficiency and quality of dissections, as well as less confusion about dissection
goals. We conclude that the Dissection Guide for Human Anatomy succeeded by helping
medical and dental students dissect a human cadaver in today's condensed curriculum
environment.
To Celine, Jared, Ireland, Gabriel and the Morton
and Templeman families
TABLE OF CONTENTS
ABSTRACT ... '" .. , .. , .................................... '" ...................................... iv
ACKNOWLEDGMENTS ......................................................................... vii
Chapter
I. INTRODUCTION .............. , ... '" ........ , ......... '" ........................ , ............. 1
II. METHODS ....................................................................................... 8
III. RESULTS ................ " .................................................................... 17
IV. DISCUSSION .................................................................................. 20
APPENDIX: DISSECTION GUIDE FOR HUMAN ANATOMy .......................... 25
REFERENCES .... , ........................................ '" ............ '" ...... '" ............ 161
ACKNOWLEDGMENTS
I would like to express my grateful appreciation to the following individuals:
Dr. Albertine and Kerry Peterson, for without their experience and countless hours of
volunteered service, this book would not have been possible
Dr. Parks for investing time and funds into my potential to write the dissection guide
Drs. Albertine, Ash, Schoenwolf, Southerland and Wiggins (members of my graduate
committee) for your suggestions and help
Drs. Cook, Cottam and Weyrich, Kelley Murphy, Neil Tolley, Rachel Tomeo,
Torrance Meyers, Sentil, Harry, Kenneth "Boll Foreman, Christine Eccles and Brian
Clothier for their help and suggestions during the past few years
In memory of Dr. L. W. Miltenberger
The medical and dental students from the classes of 2003-2006 at the University of
Utah School of Medicine
The giving individuals who donated their bodies for students to gain an understanding
of human anatomy and to marvel at the magnificence of the human body
My parents Gordon and Gabriella Morton who taught me to appreciate the miracle of
the human body and my brothers, sister and in-laws (Templeman and Morton) for
their unending encouragement
My wonderful wife Celine and our children Jared, Ireland and Gabriel ... my
inspiration
INTRODUCTION
Human gross anatomy courses are typically presented as sequential didactic
lectures and laboratory dissections in medical and dental schools. The biggest challenge
today for gross anatomy courses results fronl the dramatic reduction in curriculum hours
that has occurred over the past six decades. The reduction in curriculum hours has
greatly decreased the time available to students for dissection of an entire cadaver. In
compounding this problem, the current dissection manuals have not been revised to
match the reduction in course hours. The present dissertation was designed, therefore, to
create a dissection guide for human anatomy that fits the current gross anatomy
curriculum at the University of Utah School of Medicine.
Human gross anatomy is one of the required core classes taken by first-year
medical students. Gross anatomy provides the foundation for understanding the make up
of the human body. It is prerequisite to understanding other basic medical classes
(embryology, histology, physiology, pathology, etc.) and to the practice of medicine.
However, during the past six decades, the number of hours devoted by medical schools to
human gross anatomy lectures and laboratories has declined. In 1939, medical schools in
the United States and Canada devoted approximately 338 hours for gross anatomy
lectures and laboratories (Eldred and Eldred, 1961). By 1955, the average number of
hours slightly declined to 330 hours (Eldred and Eldred, 1961). Course hours declined
precipitously to 290 hours by 1966, 197 hours by 1973 (Blevins and Cahill, 1973) and
182 hours by 1991 (Collins et ai., 1994). In the year 2002, the average total course hours
2
for gross anatomy in medical schools was 167 hours (Drake, Lowrie and Prewitt, 2002).
At the University of Utah School of Medicine, curriculum hours fall short of the national
average, being 137 hours for the gross anatomy course. The decline in the number of
hours dedicated to gross anatomy seems to be attributed to the dramatic advances in cell
biology, microbiology, physiology and phannacokinetics and the instructional hours that
must be devoted to these subjects (Drake, Lowrie and Prewitt, 2002). Another factor that
nlay playa part in this decline is incorporation of different approaches to education, such
as more small group learning, problem based leanling, and increased use of computer
assisted learning strategies (Drake, 1998; Giffin and Drake, 2000). Despite the dramatic
decline, students are still expected to dissect an entire cadaver in what is now a drastically
a reduced period of time.
Prior to the 1997-98 academic year, the gross anatomy course at the University of
Utah School of Medicine was taught during a seven-month period, from September (first
week) to March (last week). Since the 1997-1998 academic year, our gross anatomy
course has been taught during a four-month period, from August (fourth week) to
December (first week). In addition to gross anatomy, medical students at the University
of Utah School of Medicine take histology, medical embryology, psychiatry, art of
medicine, and community patient courses between September and mid December.
Students are encouraged do well in gross anatomy because a lack of understanding in
anatomy may affect their futures as physicians since medicine is grounded on an
understanding of the human body. However, the students' attention is diverted by
conlpeting courses that are taught during a short period.
3
Many of the current commercial dissection manuals were written years ago when
time available for gross anatomy exceeded 200 hours. Although many of the current
dissection manuals have been revised since their first edition, they are not designed to
direct efficient dissection in today's truncated curriculum time frame. The main problem
with most of the current dissection manuals is they include much of the same information
as gross anatomy textbooks. As a result of this thoroughness, current dissection manuals
are difficult to use as dissection guides because the anatomic text is dispersed among the
dissection instructions. Thus, the anatomic text interrupts the dissection instructions.
From students' perspective, too much searching is required to locate the dissection
instructions. Another linlitation is that lists of anatomic structures are not provided in the
current dissection manuals, which would efficiently guide students regarding what they
are expected to learn.
Some of the most frequently used dissection manuals commercially available
include Grant's Dissector (Sauerland and Sauerland, 1999), The Stanford Project (Chase,
Dolph, Glasgow, Gosling, Mathers, 1996), Dissector for Netter's Atlas of Human
Anatomy (Oberg, 1994), Clemente's Anatomy Di..\'sector (Clemente, 2002) and Anatomy.
A Dissection Manual and Atlas (Jacob, 1996).
Grant's Dissector is one of the most commonly used dissection manuals in health
profession schools across the nation. Grant's Dissector contains a great deal of
anatomical text mixed with instructions for dissection. Yellow highlighting is used to
draw attention to the dissection instructions. Despite this highlighting approach,
dispersion of the dissection instructions in the voluminous text makes pinpointing the
dissection instructions difficult. Grant's Dissector has good illustrations to guide
students, but many of the illustrations are extraneous to the task of dissection.
Furthermore, most of the illustrations are not positioned on the page with the relevant
dissection instructions. Consequently, students use valuable dissection time flipping
pages back and forth looking for illustrations and sifting through long sections of text in
search of dissection instructions.
4
The Stanford Project is a dissection manual formatted in a three-ring binder and
referenced to a corresponding atlas called the Clinical Anatomy Atlas (Chase, Dolph,
Glasgow, Gosling, Mathers, 1996). The pages are laminated, which permits them to be
easily cleaned when soiled with preserving fluid and debris. Very simple color
illustrations are provided on each page, with instructions directing students to the atlas for
further illustrations. Herein lies a problem: students use a good deal of their time
searching the atlas to find illustrations related to their dissection, in part because of the
paucity of illustrations in the dissection manual. Another problem is the dissection
instructions are brief and therefore do not provide complete guidance.
The Dissector for Netter's Atlas of Human Anatomy is not practical as well. It
contains illustrations similar to the Atlas of Human Anatomy (Netter, 1997); however, the
illustrations in the dissection guide are small and unclear and often do not provide an
appropriate example of structures described on the page. The dissection instructions also
furnish insufficient direction to dissect and identify structures.
Clemente's Anatomy Dissector (Clemente, 2002) and Anatomy. A Dissection
Manual and Atlas (Jacob, 1996) are both formatted similarly to the above listed manuals.
Therefore, neither Clemente's nor Jacob's guide address the problem faced by medical
students to efficiently perform dissections.
5
Grant's Dissector was used at the University of Utah School of Medicine prior to
the fall of 2000 and the students were unable to finish the assigned dissections by the end
of each laboratory period. Consequent! y, they had to return to the gross anatomy
laboratory after hours to finish their dissections. This situation was a problem years ago,
when the gross anatomy course was spread over seven months. Since the 1997-98
academic year, the gross anatomy course has been taught in four months. Therefore, the
problem of not being able to complete the assigned dissections has become even more
pressing. Furthermore, complaints increased from the students regarding the lack of lists
of anatomic structures that they are expected to dissect and therefore learn.
The solution to this dilemma described here was to create a practical dissection
guide for human anatomy that contains the following attributes:
Written instructions - the written instructions should be clear and complete for
students to understand, to dissect, and to identify anatomical structures. Students
should also know what they were expected during each dissection session.
Illustrations - enough illustrations should be included to visually direct the student's
dissection and to identify all of the anatomical structures. The illustrations should
also be clear and simple.
Format - the layout of the dissection guide should allow the text and illustrations to be
side by side to avoid unnecessary page turning.
Efficiency - the dissection guide should allow students to be efficient and to finish
every dissection within the laboratory period.
6
Initially I began by writing the first half of the Dissection Guide for Human
Anatomy as my master's degree thesis. The principles whereby the guide was written
incorporated the four aforementioned attributes. I organized the manual for students to
efficiently complete a dissection during the time allotted. Text was edited to be concise
and focused while still providing clear instructions and identifications. Furthermore,
each page contained text and at least one corresponding picture illustrating dissection
technique and/or structures to identify. The initial dissection guide was used at the
University of Utah School of Medicine for their cadaver dissections during the fall of
1999. The guide was such a success that I continued the project as my doctorate
dissertation. My goal was to finish the dissection guide. Since the completion of my
master's degree in the spring of 2000 I completed the manual and signed a contract with
Elsevier Science during the spring of 2002 to publish the dissection guide internationally.
The guide was then sent to various anatomy authors around the country for their critique.
The full version of the dissection guide was used at the University of Utah School
of Medicine during the past three academic years (fall 2000-2002). The dissections were
completed in the allocated time and the students required less guidance from instructors
compared to previous years.
We conclude that the Dissection Guide for Human Anatomy is a practical manual
for teaching human gross anatomy to medicat dental and graduate students. We
speculate that this manual will be useful for teaching gross anatomy to health profession
students in other disciplines.
7
METHODS
The philosophy behind writing Dissection Guide for Human Anatomy was to
produce a guide for efficient dissection of the human body. The philosophy was not to
produce a textbook or an atlas of the human body. My goal was to make the guide
practical and easy to follow for medical and dental students so that they will finish each
dissection during an assigned laboratory period. Another goal was to provide the
students with clear expectations of the material to be dissected and learned. This required
that I select a format to subserve each goal. I wrote each of the chapters for the
dissection guide and illustrated the pictures. With the help of my co-authors, Kurt H.
Albertine and Kerry D. Peterson, the text and images were then edited numerous times to
ensure optimal dissection instructions.
Selecting the best possible format for the Dissection Guide for Human Anatomy
proved challenging. One of the challenges was to juxtapose text and the related
illustration(s) on the same page. This challenge was met by orienting the pages
horizontally (often referred to as landscape format). By selecting a horizontal page
format, I was able to position the text on the same page as the corresponding
illustration(s). Thus, each page is divided in halfby a vertical bar, with text positioned
on the left and the corresponding illustration(s) on the right.
A related challenge was stability of the guide on the bookracks that are attached to
the dissection tables in the gross anatomy laboratory. The bookracks are wider than they
are tall, and they are slanted slightly backward. Therefore, tall books tend to fall off the
9
bookracks. This problem was inadvertently reduced by the horizontal page format and by
spiral binding the guide on the short side of the pages. When the guide is opened, two
pages are displayed horizontally. Thus, the guide is wider than it is tall and therefore is
stable on the bookracks. An added benefit of this formatting design is the information on
two pages is displayed.
Font format was assigned as 12-point to make the font large enough to read but
not so large that little text fit onto a page. Each page was formatted as a two-column
table. The table format simplified setting the margins. Another benefit of the table
format is it held the inserted pictures at the location where they were inserted. Had I used
Microsoft Word (Microsoft Corporation, Redmond, WA) in its nonnal page format, the
enormous number of pictures would have been inserted as object files. However,
Microsoft Word is not designed to handle large numbers of inserted objects. Once
Word's threshold is reached, the next object files that are inserted cause all of the inserted
object files to move randomly throughout the document. The only way that I could
prevent this disastrous consequence was to format the pages as two-column tables.
I assigned bold font style to the names of anatomic structures the first time that a
structure was identified in the text. I used this design for two reasons: 1) to signal to
students that the named structure is to be dissected and identified and 2) to highlight a
"hotlink" to image files in the Web-based translation of the dissection guide that is being
composed as a companion to the dissection guide. The Web-based version contains
photographs of prosections, bones, models and radiographs. By using "hotlinks" to
connect the text to the image folders, I created a rapid means for students to efficiently
view high-resolution images of anatomic structures.
10
The illustrations in the guide are simple line drawings displayed in black-and-
white. I created each of the drawings, so they do not infringe copyright laws. I chose the
black-and-white style because it focuses the students' attention on a specific dissection
task. A rainbow of colors does not distract their attention. Also, black-and-white
illustrations are inexpensive to print.
Each illustration was hand-drawn with pencil. Guidance for the illustrations came
from viewing the following gross anatomy textbooks and atlases: Anatomy A Regional
Atlas of the Human Body (Clemente, 1981), Atlas of Human Anatomy (Netter, 1997},
Clinically Oriented Anatomy (Moore and Dalley, 1999), Color Atlas of Human Anatomy
(McMinn and Hutchings, 1988), Grant's Atlas of Anatomy (Agur and Lee, 1999) and
Grant's Dissector (Sauerland and Sauerland, 1999). Tips for perspective and proportion
were gleaned from Anatomy for the Artist (Barcsay, 2000) and Artistic Anatomy (Richer
and Hale, 1986). The illustrations were edited by Kerry Peterson and Dr. Albertine, who
emphasized simplicity, clarity and necessary labeling only. I did not want to complicate
the illustrations with numerous labels. Black ink was traced over the revised pencil lines.
The revised pen-and-ink illustrations were scanned into Adobe Photoshop (Adobe
Systems Incorporated, San Jose, CA), using a flatbed scanner (Epson America
Incorporated, Long Beach, CA) connected to a PC-compatible computer.
I used Adobe Photoshop to add text, lines and shading and to crop the
illustrations. The illustrations were saved as three versions. The first version was the
11
original scanned illustration, saved in Tiff (.tit) format. The second version of the
illustration as an Adobe Photoshop document (.psd) after the text, lines and shading were
added. The Photoshop file format preserves the text, lines and shading as independent
layers. The third version was the final product, in which all of the Photoshop layers were
flattened into a single layer. The third version was also saved in Tiff format.
The utility of saving each illustration as three versions was discovered during the
revision process, when text labels were modified, lines were altered and/or shading was
adjusted. Flexibility to change one or more layers, without altering other layers, is
provided by files that are saved as Photoshop documents.
Once the illustrations were revised, saved as Photoshop documents and flattened
as tiff files, the illustrations were inserted into a text box in Microsoft Word within the
table format. The text box option allowed us to position each illustration appropriately
on the right half of the horizontally formatted page. The text box option also allowed me
to adjust the size of the inserted illustration to the available space on the page.
Dissection Guide for Human Anatomy is organized according to the schedule for
the human gross anatomy course taught at the University of Utah School of Medicine.
This course is divided into the following four units.
Unit 1: Back and Thorax
Unit 2: Abdomen, Pelvis and Perineum
Unit 3: Neck and Head
Unit 4: Limbs
Each unit is subdivided into individual laboratory periods. The number of laboratory
periods in each unit varies.
This doctorate dissertation presents the entire Dissection Guide for Human
Anatomy. The Units of the dissection guide are divided into the following laboratory
periods:
Unit 1 - Back and Thorax
1. Superficial Back
2. Deep Back and Vertebral Column
3. Spinal Cord
4. Anterior Chest Wall and Breast
5. Thoracic Situs and Lungs
6. Heart
7. Mediastina
Unit 2 - Abdomen, Pelvis and Perineum
8. Anterior Abdominal Wall
9. Peritoneum and Foregut
10. Midgut and Hindgut
11. Posterior Abdominal Wall
12. Gluteal Region and Ischioanal Fossa
13. Urogenital Triangle
14. Pelvis and Reproductive Systems
Unit 3 - Neck and Head
12
13
15. Posterior Triangle of the Neck
16. Anterior Triangle of the Neck
17. Visceral Triangle, Brain and Base of Skull
18. Base of Skull and Cranial Nerves
19. Orbit
20. Superficial Face
21. Deep Face and Pharynx
22. Nasal Cavity, Palate and Oral Cavity
23. Larynx and Middle Ear
Unit 4 - Limbs
24. Upper Limb: Osteology and Superficial Structures
25. Upper Limb: Musculature
26. Upper Limb: Nerves
27. Upper Limb: Vasculature
28. Upper Limb: Hand
29. Upper Limb: Joints
30. Lower Limb: Osteology and Superficial Structures
31. Lower Limb: Musculature
32. Lower Lirnb: Nerves
33. Lower Limb: Vasculature
34. Lower Limb: Foot
35. Lower Lirnb: Joints
14
The guide for each laboratory dissection period begins with a table that identifies
the structures to be dissected. The pages that follow contain the text and illustrations
directing the students' dissection. At the end of each unit, a comprehensive table
identifies all of the structures that were dissected and therefore to be learned. These
tables do not identify every anatomic structure that is present in a region, for example as
presented in the British or American editions of Gray's Anatomy (Gray, 1977, 1973). I
did not make the tables all-inclusive because the current anatomy course is only 137
hours. The course does not have sufficient time to include every anatomic structure.
Therefore, the tables in Dissection Guide for Human Anatomy represent my editorial
decision for inclusion. My decision for inclusion is based on practical experience during
the past four years, when I learned the limits of inclusion by trial and error, as well as by
student feedback. I recognize that my dissection guide is a distillate and not the total
body of gross anatomic information.
I revised the guide four times before it was used for our human gross anatomy
course in the fall of 2000, when the guide was student-tested by 104 medical students and
10 dental students. Since then, the department of Neurobiology and Anatomy has used
the dissection guide during the fall of 2001 and 2002, with over a 100 medical and 10
dental students per academic year. Throughout the course each year, student input was
solicited for identification of errors and suggestions for improvement. At the end of each
year's course, a questionnaire was given to every student to obtain anonymous critique of
the dissection guide. These forms of critical evaluation prompted additional revision.
15
In May of2002, the authors of the Dissection Guide for Human Anatomy
(Morton, Peterson, Albertine) signed a contract with Elsevier Science (Elsevier Science,
St. Louis, MO) for publication. Numerous human gross anatomists from other medical
schools in the United States and United Kingdom reviewed the dissection guide and
submitted suggestions for improvement. Using three years of student feedback, and
suggestions from other anatomists, I composed the final version of the dissection guide
for publication.
To help determine the dissection guides effectiveness, a questionnaire was
distributed to the medical and dental students after they completed the anatomy course in
the fall of 2002. The questionnaire was distributed two months following the completion
of the anatomy course. All students received the questionnaire; 41 completed the
questionnaire. Based on the dissection guide's format and philosophy, the questionnaire
consisted of questions to be answered on a five-point Likert scale ("strongly agree" = A,
to "strongly disagree" E). The questionnaire addressed the text, illustrations, format,
and efficiency of dissection (copy of the questionnaire is attached) and was e-mailed in
February 2003, followed by a reminder one week later.
Responses were collected from 41 first-year nledical students (41
0
10 response
rate). The respondents included 30 (73%) men and 11 (270/0) women, with the mean age
of 26 years. Most of the participants were predominantly from white descent (95%), with
a small percent being from Hispanic descent (5%). Those who participated in the
questionnaire came from a variety of educational backgrounds (See Table 1.)
Only 31 % of the questionnaire participants had no academic experience in a
human gross anatomy course prior to medical school (see Table 2.).
Table 1. - Degrees earned by medical students
Degree categories* N urn ber of J,articipants
Biological sciences 23
Phy_sical sciences 6
Liberal arts 6
Other 7
Master's degrees 5
* Associates degrees and minors were not included in this chart
* SOlne students had double majors and more than one degree
Table 2. - Academic experience in human gross anatomy
16
Academic experience N urn her of participants
Combined anatomy and physiology course 23
Plastic model-based 5
Human cadaver-based, without perfonning 22
dissections
Human cadaver-based, with performing dissections 5
Teaching assistant for a human gross anatomy 5
course I
RESULTS
The Dissection Guide for Human Anatomy consists of over 420 pages of text and
more than 450 original black-and-white illustrations (see Appendix). The pages are
oriented horizontally. The left side of the page contains the text and the right side
contains the corresponding illustration( s). The left margin was bound with a spiral
allowing the guide to be opened to two pages simultaneously and giving the book
structural stability on the bookracks are attached to my dissection tables. The
illustrations are simple line drawings that are displayed in black-and-white. The black-
and-white style focuses the students' attention on the dissection task. Labels are kept to a
minimum for the same reason.
Each illustration is saved as three versions. The first version is the original
scanned illustration in Tiff format. The second version contains the added text, lines and
shading and is saved as an Adobe Photoshop document. The third version is the final
product, in which all of the Photoshop layers are flattened into a single layer. The third
version is also saved in Tiff format and inserted in the completed guide.
The dissection guide contains dissection instructions for 35 laboratory periods.
Each laboratory period's instructions begin with a structure list. Each unit ends with a
comprehensive list of structures that were to be dissected.
18
Prior to the 1997-98 academic year, students lost time guessing the direction each
dissection was to take and knowing what was required of them to learn during each
laboratory session. During the past three academic years, when students used the
Guide for Human Anatomy, both problems were minimized. Also, the
dissections were accomplished more efficiently and with less guidance from the
laboratory instructors. As a result, students finished each dissection by the end of the
laboratory period. Because the dissections were perfonned more efficiently and required
less guidance by instructors, more teaching and discussion of anatomy was possible.
The results from the questionnaire are as follows:
Text
93% (38 of 41) of the participants responded that they agreed that both lists
accurately covered the structures that would be dissected during the laboratory
period.
76% (31 of 41) of the participants felt that the dissection instructions were clear
and 90% (37 of 41) felt the dissection instructions followed an orderly and logical
sequence.
Illustrations
62%) (25 of 41 ) of the participants disagreed that anatomical atlases and other
reference books were necessary in order to accomplish the dissections.
81 % (33 of 41) of the participants felt that illustrations were easy to interpret and
71 % (29 of 41) felt that the figure labels were consistent with the accompanying
text.
19
74% (30 of 41) felt that the figures contained sufficient information to reveal and
identify the desired structures.
Format
95% (39 of 41) of the participants agreed that the landscape fonnat, with text on
the left and figures on the right, enabled easy reference while dissecting.
880/0 (36 of 41) of the participants liked the bulleted format of the text because it
made following the dissection instructions easy.
Efficiency
790/0 (32 of 41) of the participants were either neutral or disagreed with the
premise that the dissections were difficult to accomplish in the scheduled time.
DISCUSSION
The Dissection Guide for Human Anatomy is completed, the four units of which
are submitted as part of the requirements for a doctorate in anatomy. The book was used
to guide dissection for first-year medical and dental students at the University of Utah's
School of Medicine during the falls of 2000, 2001 and 2002. The students successfully
completed dissections by the end of each laboratory period and required less guidance
from the laboratory instructors. Thus, more time was available for laboratory instructors
to teach human gross anatomy and discuss clinical correlation than in previous years. The
manual helped the laboratory instructors prepare for each session and fewer anatomy
atlases were used by students in the laboratory.
Human gross anatomy is one of the required core classes taken by first-year
medical students because it is the foundation on which many other medical courses and
disciplines build. Student mastery of gross anatomy is important for this reason. For
example, during their second year in medical school, students cover body systems from a
clinical approach. Unless medical students possess a "big picture
ft
understanding of these
body systems' anatomical makeup, they will lack a complete understanding necessary for
future practice. As a result, failure to master gross anatomy may adversely affect medical
students' future practices as physicians.
In 1939, medical schools devoted 338 hours to gross anatomy lecture and
laboratory (Eldred and Eldred, 1961). This amount of time allowed the enormous
volume of anatomical material to be taught, at some institutions over a two-year period
21
(Eldred and Eldred, 1961). The medical students used books such as Gray's Anatomy
(Gray, 1977) to learn detailed anatomic descriptions and to dissect the human body. As
time progressed and scientific advancements in biomedical sciences expanded, curricula
were modified to accommodate the new information. The modifications necessitated
reduction in curriculum tinle for core basic science courses. Consequently, human gross
anatomy curriculum hours were progressively reduced. For example, in 1955, the
number of hours dropped slightly to 330 hours in the United States and Canada (Eldred
and Eldred, 1961). By 1966, the time allocation was down to 290 hours. Reduction has
not stopped since then. Human gross anatomy courses dwindled to 197 hours in 1973
(Blevins and Cahill, 1973), 182 hours in 1991 (Collins et aL, 1994) and 165 hours in
1997.
The University of Utah School of Medicine is currently at par with most medical
schools in the year 2000. The human gross anatomy course is but 137 hours. This time
frame incorporates lectures, laboratories and examinations. The course is partitioned into
31 sessions, each composed of a one-hour lecture followed by two to three hours of
laboratory dissection. Thus, only a fraction of the time is available today to teach human
gross anatomy compared to six decades ago.
Although gross anatomy curriculum hours are reduced, students are still required
to dissect an entire cadaver. However, the current dissection manuals are written as
though medical students have ample time to dissect and learn. Current dissection
manuals, such as Grant's Dissector (Sauerland & Sauerland, 1999), contain large
volumes of text describing the gross and clinical anatomy. The text is written in the style
of a textbook. Medical students today do not have the time to sift out the dissection
instructions from the text.
22
Grant's Dissector (Sauerland & Sauerland, 1999) responded to the current
situation by highlighting the dissection instructions in yellow to separate the dissection
instructions from other text. The problem still remains, however, of having too much text
that distracts and confuses the students during dissection. Dissection Guide for Human
Anatomy addresses the time constraint challenge by excluding extraneous text and thus
promoting efficiency. Moreover, by avoiding duplication of material from textbooks, my
guide provides clear, straightforward instructions for dissection of the hwnan body.
Grant's Di..\'sector (Sauerland & Sauerland, 1999) also contains numerous
illustrations, many of which appear to have limited utility during dissection. Also, many
of the illustrations are separated from the corresponding text. A common complaint by
students is they lose time flipping pages back and forth, trying to correlate the
instructions to the illustrations. Dissection Guide for Human Anatomy solves this
problem by having the text and corresponding illustration(s) on the same page.
The difficulty with the Dissector for Netter's Atlas of Human Anatomy (Oberg,
1994) is that it provides minimal dissection instruction and anaton1ic structure
description.
The Standford Project (Chase, Dolph, Glasgow, Gosling, Mathers, 1996) contains
useful dissection however, more are needed from the student perspective.
The Standford Project manual directs students to another atlas to study images of
dissected regions. Students struggle to interleaf the two books while they dissect. Again,
Dissection GUidefor Human Anatomy solves this problem by placing the appropriate
illustration(s) beside the corresponding text.
23
In Dissection Guide for Human Anatomy, each laboratory dissection instruction
begins with a table that identifies the structures to be dissected. The pages that follow
contain the text and illustrations directing the students' dissection. At the end of each
unit, a comprehensive table identifies all of the structures that were dissected and
therefore are to be learned. However, these tables do not identifY every anatomic
structure that is present in a region. I did not make the tables all-inclusive, as presented in
the British or American editions of Gray's Anatomy (Gray, 1977, 1973), because the
course today is only 137 hours, and the students lack sufficient time to identifY every
anatomic structure. Therefore, the tables in Dissection Guide for Human Anatomy
represent my editorial decisions for inclusion. I recognize this limitation for each list. I
endeavored to include the main anatomical structures from each region of the body to aid
the students, learning effort. Consequently, when a student studies a body region in more
detail (i.e., during the surgical rotation in the third and fourth year of medical school),
he/she will have the anatomical background necessary to be successful.
The dissection guide will be translated to a Web-based multimedia teaching tool.
I created the template for this teaching tool during the summer of 2000 and tested it
during the gross anatomy course last fall. I envision that the students will use the web-
based version to study the laboratory material from their home or library.
A limitation of Dissection Guide for Human Anatomy is absence of clinical
correlations. My guide suffers from this omission because student enthusiasm increases
24
when they see clinical relevance. Our challenge will be to integrate clinical correlations
to the Web-based translation.
Another limitation to this study is the lack of an educational outcome's
comparison between the Dissection Guide for Human Anatomy and commercially
available dissections guide (i.e., Grant's Dissector). Without such a comparison, I can
not correlate the dissection guide's effectiveness with an already available commercial
dissection guide. Such a comparison will be performed this summer (2003) and next
(2004). For this reason I have sought and obtained funding to conduct a prospective,
educational outcome research project over the next two summers. I will have a group of
40 students who have been accepted as first-year medical students at the University of
Utah School of Medicine (class of 2007). Another group of 40 students will be enrolled
from the class of 2008. Each group of 40 students will be divided equally into two
groups. One group will use the Dissection Guide for Human Anatomy, and the other
group will use Grant's Dissector. Another 40 students will be recruited from the
subsequent class of medical students. I will compare efficiency of dissection and indices
of comprehension between the two groups. The students will fill out a daily log to
address issues about each dissection and to determine the number of structures identified
during each dissection period.
APPENDIX
DISSECTION GUIDE FOR HUMAN ANATOMY
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