Anatomy atlases

Anatomy atlases are unlike other knowledge sources in the health sciences in that they communicate knowledge through annotated images without the support of narrative text. An analysis of the knowledge component represented by images and the history of anatomy atlases suggest some distinctions that should be made between atlas and textbook illustrations. Textbook and atlas should synergistically promote the generation of a mental model of anatomy. The objective of such a model is to support anatomical reasoning and thereby replace memorization of anatomical facts. Criteria are suggested for selecting anatomy texts and atlases that complement one another, and the advantages and disadvantages of hard copy and computer‐based anatomy atlases are considered. Clin. Anat 12:293–299, 1999. © 1999 Wiley‐Liss, Inc.     

Anatomy,the writing of a textbook

The history of the production of a textbook of human anatomy is recounted. The objective was to compose a volume that would (1) be regional rather than systemic in organization, (2) be a concise guide for both medical and dental students, and stress points of clinical importance, (3) be clearly illustrated but not be a substitute for an atlas, (4) include excellent radiographs and examples of other methods of imaging, (5) use the (then new) internationally accepted nomenclature, but provide a glossary of eponymous terms, and (6) treat the subject as a university discipline with its own history and encompassing an appropriate literature, including both strictly anatomical and clinically applied references. It should be remembered that at that time, more than 30 years ago, these notions were not nearly as frequently encountered in practice as they might be today, although even now it would be difficult to find a textbook in which all of the above features are combined. © 1993 Wiley-Liss, Inc.     

Team-based learning in a medical gross anatomy and embryology course

The application of team-based learning (TBL) as a major component of a medical gross anatomy course was evaluated. TBL is a method of small group instruction that addresses some of the shortcomings of other small-group teaching approaches. The core components of TBL were instituted in 12 small group sessions in the course. Each session included objective-oriented assignments, an individual readiness assurance test, a group readiness assurance test and a group application problem. Peer evaluation was carried out on a regular basis. Scores from TBL session activities and course examinations were analyzed and compared to previous years' course performance. Student course evaluation data and faculty feedback were also collected. Student evaluation data and faculty response indicated strong support for the TBL method as it was implemented in the course. Faculty noted improvements in students' day-to-day preparedness and group problem solving skills. Students' mean scores on exams were not significantly different from those of previous years. There was, however, a significantly smaller variance in examination scores that was reflected in a lower course failure rate compared to previous years. Correlation analyses of TBL and examination performance suggested that individual readiness assurance test performance is a good predictor of examination performance. TBL proved to be a superior method for small group learning in our anatomy course. Student performance suggested that TBL may most benefit academically at-risk students who are forced to study more consistently, are provided regular feedback on their preparedness and given the opportunity to develop higher reasoning skills.     

Approach to the educational opportunities provided by variant anatomy, illustrated by discussion of a duplicated inferior vena cava

Variant anatomy recognized during routine cadaveric dissection in the first year of medical school offers great learning potential by allowing students to gain enhanced understanding of an array of important subjects. It provides a framework for reviewing common morphology and embryogenesis of the structure in question, and through the help of appropriate faculty, yields insight into the potential medical, radiologic, and surgical implications. The frequency of clinically important anatomic variation is high enough to allow the gross anatomy laboratory to serve as an excellent teaching platform in this regard. Through anatomy, the student is introduced to the concept of patient individuality, and to the individualization of medical and surgical therapies. Recently, one of the variations encountered in our lab was a duplicated inferior vena cava. We describe our approach to such findings through a systematic discussion of the anatomy and embryology, as well as the radiologic and clinical correlates.     

Fascicular analysis at perineurial level of the branching pattern of the human common peroneal nerve

The macroscopic branching pattern of the peripheral nerves is usually provided by the epineurial connective tissue, whereas the removal of the epineurium discloses component fascicles covered by a perineurial sheath comprising a fine network with a peculiar branching pattern. In order to compare both patterns, the common peroneal nerve (PC) was dissected minutely in 10 human legs. At the epineurial level the branching pattern into tributary bundles was variable in respect to both the origin of the superficial peroneal nerve and that of the muscular branches (Rr. m. peroneus longus, RPL) to the peroneus longus. At the perineurial level the fascicles formed intricate tiny plexuses without a discrete branching pattern, but as a whole consisted of a regular arrangement divided into four crural streams for the deep peroneal (PP), the accessory deep peroneal (PPA) and two dorsal cutaneous nerves. The RPL fascicles were derived substantially from the PPA stream. The findings on the fascicular branching pattern in the present study show that the PC consists of two muscular and two sensory streams that were ensheathed by the epineurium to form the PP containing a single muscular stream, and the superficial peroneal nerve with the three remaining streams. Thus the extensor and peroneal muscles of the leg have their own nerve supply from the PP and PPA, respectively. The branching pattern of the fascicles of muscular branches at the perineurial level may be a useful estimator of muscle grouping, for which the branching pattern at the epineurial level is hardly of any use due to its variability.     

Workshop in clinical anatomy for residents in gynecology and obstetrics

A workshop in the clinical anatomy of the female pelvic viscera has been part of the training program for the first year residents in Gynecology and Obstetrics at the University of Padova since the 1999-2000 academic year. The purpose of the workshop is to offer a direct experience of practical anatomy despite a shortage of cadavers. It is designed for six residents who work in three teams on three specimens. The anatomical specimens are unembalmed, unfixed, female pelvic visceral blocs that are harvested from the cadavers 24 hr after death. They are stored at -12 degrees C and removed from the freezer 12 hr before the workshop. The workshop is 3 hr in length and has two parts: one on theory and one practical. In the theoretical section (30 min), the teacher presents the topographical anatomy of the specimens and the residents analyze a clinically oriented worksheet. In the practical section (2 hr), the residents identify viscera, vessels, and nerves through inspection and palpation, and then a step-by-step dissection is carried out. In the last section (30 min), the workshop includes presentations on the three specimens that illustrate anatomical variability and assess knowledge of topographical anatomy. For many residents, this is the first practical experience of the anatomy of the female pelvic viscera because the anatomical courses for medical students do not include direct dissection by students. The unfixed viscera preserves the natural characteristics of the different tissues that exhibit the aspects of living organs, such as color, softness, and pliability, enhancing the knowledge of anatomy. The worksheet is structured as a guide to the anatomical basis of physical examination through inspection and palpation of the viscera. It also introduces the residents to the surgical anatomy of the female pelvis through a brief and selective dissection focused on the relationship between the different regional systems.     

Gross anatomy of the head and neck and neuroscience in an integrated first‐year medical school curriculum

The curriculum for first year medical students at the University of Cincinnati has changed. Beginning in the fall of 1998, material in the first year was presented in an Integrated Educational Program. The goal of this program was to provide students with an understanding of the normal structure, function, and development of the human body. The purpose of this report is to discuss the unique integration that occurs in a block offered during the Spring Quarter. The two components of this block are Gross Anatomy of the Head and Neck and Brain and Behavior I. Brain and Behavior I is a new offering combining neuroanatomy, neurophysiology, neurology, and a psychiatry/behavioral component. The unique combinations offered in this block are logical, educationally sound, and have been enthusiastically received by both the students and faculty. Anat Rec (New Anat) 261:89–93, 2000. © 2000 Wiley‐Liss, Inc.     

Relationship of the recurrent laryngeal nerve to the inferior thyroid artery: A comparison of findings from two systematic reviews

Systematic reviews (SRs) of anatomical studies may include a meta‐analysis (MA) that provides weighted averages as pooled estimates of prevalence. The relationship of the recurrent laryngeal nerve (RLN) to the inferior thyroid artery (ITA) or its branches has been assessed in two published SRs, one without MA of 32 studies (SR1) and the other with MA of 79 studies (SR2). Both SRs reported differences in RLN–ITA patterns (in three categories) by side of the body, but the anterior pattern was less frequent in SR1 vs. SR2. The aim of this review was to explain the differences. The unweighted data from SR1 were found to be more affected (vs. SR2) by a single study with the largest number of RLNs and a low proportion anterior. In a MA using data from SR1, the pooled prevalence estimate for the anterior pattern was substantial (35%) on the right side (vs. 15% on the left) and close to the findings published in SR2. These consistent findings should be relevant to surgeons in attempting to avoid iatrogenic injury to RLNs. Comparison of methods and results from two or more SRs on the same anatomical relationships may be useful in evidence‐based anatomy. Clin. Anat. 30:318–321, 2017. © 2017 Wiley Periodicals, Inc.     

The virtual anatomy practical: A stereoscopic 3D interactive multimedia computer examination program

Continuing advances in computer visualization and interface technologies have enabled development of “virtual reality” programs that allow users to perceive and to interact with objects in artificial three-dimensional environments. Such technologies were used to create an image database and program for administering a practical examination in human gross anatomy. Stereoscopic image pairs of prepared laboratory dissections were digitized from multiple views of the thorax, abdomen, pelvic region, and upper and lower extremities. For each view, the stereo pairs were interlaced into a single, field-sequential stereoscopic picture using an image processing program. The resulting color-corrected, interlaced image files were organized in a database stored on a large-capacity hard disk. Selected views were provided with structural identification pointers and letters (A and B). For each view, appropriate two-part examination questions were spoken by a human narrator, digitally recorded, and saved as universal audio format files on the archival hard disk. Images and digital narration were organized in an interactive multimedia program created with a high-level multimedia authoring system. At run-time, 24-bit color 3D images were displayed on a large-screen computer monitor and observed through liquid crystal shutter goggles. A 90-second interval timer and tone were provided to give student users a time limit for each question comparable to that of a conventional practical examination. Users could control the program and select regional “subexams” using a mouse and cursor to point-and-click on screen-level control words (“buttons”). Clin. Anat. 11:89–94, 1998. © 1998 Wiley-Liss, Inc.     

Introduction of Case Based Learning for Teaching Anatomy in a Conventional Medical School

Anatomy which forms the foundation of medical science is perceived to be a difficult and dry subject. To make it interesting and clinically useful, good understanding of anatomical basis of diseases is required. One of the important innovative methods being used to facilitate this is case based learning (CBL). We introduced case based learning for 1st year MBBS students in 2008. Keeping in mind all-round education of students, we evaluated student's feedback concerning their perceptions towards the method, its conduct & the role of facilitator to the various aspects of CBL. The time period of the study was around nine months.One hundred students of 1st MBBS were given five paper based CBL module conducted in two sessions. The first session comprised of small group discussion amongst the students in presence of a facilitator. In the second session various groups presented their discussion outcomes. Anonymous feedback was taken from them after the end of the session & analysed.Total 83 students responded to the feedback. The percentage of students agreeing to various questions was in the range of 51 to 87%. Group discussions during CBL were able to improve the understanding of theory taught along with better problem solving and increased interaction, as agreed upon by 62, 69 and 74% of students respectively. Facilitators were found helpful by 73%; and 71% felt it was feasible to have CBL along with lectures. From our experience and students perceptions it can be concluded that CBL is a very good approach to initiate student centred learning. This also helps students to understand practical application of the theory taught to them.     

Teaching and learning gross anatomy using modern electronic media based on the visible human project

This article reviews online (Internet) anatomy projects and multimedia productions (books and CD-ROMs) based on the Visible Human Project (VHP) of the United States National Library of Medicine. The focus of these projects and productions is on the teaching of 3D anatomy using the digitized sections of the visible human male and female. The article also provides information about the VHP, its goals and what it has achieved thus far.     

Anatomy online: presentation of a detailed WWW atlas of human gross anatomy--reference for medical education

We present an online anatomy atlas based on the Visible Human Project (VHP) of the US National Library of Medicine. The objective is to provide original unlabeled as well as labeled sections of the human body of high quality and resolution on the Internet, for use in basic and continuing medical education. For a representative overview of the body, 370 axial sections were selected from the male and female data base of the VHP with special regard to regions of clinical interest. Each section is accompanied by its corresponding computer tomography (CT) image and, if available, magnetic resonance images (MRI) for quick and easy comparison of morphologic and radiologic structures. The sections can be studied unlabeled or labeled according to the current Terminologia Anatomica. A linked vocabulary with more than 850 terms explains the labeling. Animations of the sections as well as of CT and MR images allow for further visualization of the topographic relationships of anatomical structures. The responses to the project indicate that students and physicians regard the Internet Atlas of Human Gross Anatomy as a most useful aid for learning and reviewing anatomical details. The atlas is accessible on: http://www.uni-mainz.de/FB/Medizin/Anatomie/workshop/vishuman/Eready.html.     

Saturated salt solution: a further step to a formaldehyde‐free embalming method for veterinary gross anatomy

In the field of veterinary anatomy, most of the specimens used in practical sessions are perfused with fixatives. Thus, they can be used for a longer time_, reducing the number of animals for educational purposes. Formalin is the most commonly used fixative, consisting of a 37% formaldehyde solution. However, formaldehyde is a powerful irritant of the eyes and airways and is considered carcinogenic, causing nasopharyngeal cancer in exposed workers and professionals. In the present study, we explored an alternative method to avoid the use of formaldehyde in specimens used for gross anatomy practical sessions. We propose an inexpensive, non‐toxic fixative that is available worldwide, such as sea salt. This method consists of a continuous perfusion of saturated salt solution for a period of 6–8 h, enabling drainage of the solution to avoid a weight increase of the specimen, and allowing salt to be retained in the tissue. The method is based on recirculation of the saturated salt solution instead of maceration. Perfused specimens retained their natural consistency and joint mobility, with no blood, resembling a piece of meat from the slaughterhouse. They could be used immediately without a maceration period, or stored in the fridge until use and then kept in a bath of saturated salt solution for future conservation. In the case of the former, no refrigeration was needed. The specimens did not have an irritating or offensive smell, and could be used for long sessions (several hours per day) and stored for long periods. However, the blood vessels used for perfusion determine the results: a less invasive approach (through common carotid arteries) gave good preservation of the musculoskeletal system, whereas more invasive access to cannulate the abdominal aorta and vena cava caudalis was required to achieve better preservation of the viscera. In conclusion, we propose that perfusion followed by immersion in a saturated salt solution is a good alternative method for the preservation of specimens used in the practical teaching of gross veterinary anatomy. It is a very simple and inexpensive technique, and is much healthier for users than traditional formalin. Moreover, specimens can be preserved for prolonged periods, and maintain a similar appearance and consistency to fresh material.     

Prevalence of the aberrant right subclavian artery reported in a published systematic review of cadaveric studies: The impact of an outlier

The aberrant or anomalous right subclavian artery (ARSA), which arises directly from the aortic arch and crosses to the right side usually behind the esophagus, is a rare but clinically important anatomical variant. A published systematic review (SR) of 15 cadaveric studies on ARSA reported that prevalence ranged from 0.2% to 13.3% of the general population; the total unweighted prevalence of ARSA was 325 cases in 13,208 bodies or 2.46%. The present review, however, found that the 13.3% figure was for 133 cases from a larger case series without a denominator. Three other studies either had an imprecise denominator or were limited to congenital conditions associated with ARSA. After exclusions and modifications, ARSA prevalence for the remaining 11 studies in the SR ranged from 0.19%, with a 95% confidence interval (CI) of 0.00‐1.08%, to 2.52% (CI= 0.69‐6.32%). The unweighted prevalence for all 11 studies combined was 1.23%, and the pooled prevalence estimate from a meta‐analysis was 1.30% (CI = 0.86‐1.82%). In conclusion, overall findings from SRs on the prevalence of rare anatomical variants such as ARSA may be affected by outliers. Clin. Anat. 30:1024–1028, 2017. © 2017 Wiley Periodicals, Inc.     

A clinical anatomy curriculum for the medical student of the 21st century: Gross anatomy

Human anatomy forms the foundation for clinical medicine: thus its place in the medical school curriculum deserves careful attention. In an attempt to provide guidance to decision-makers involved in clinical anatomy curriculum development at the medical school level, the Educational Affairs Committee of the American Association of Clinical Anatomists (AACA) developed this document, which defines the contours of a gross anatomy curriculum leading to the M.D. or D.O. degree. The main body of the document sets forth the anatomical concepts as well as the subject matter a student should master prior to graduation from medical school. The AACA seeks to ensure that all medical students receive thorough training in clinical anatomy and that each student, regardless of the institution attended, will be exposed to a curriculum that will provide a fundamental level of competence required for the practice of medicine. © 1996 Wiley-Liss, Inc.     

Adaptive eLearning modules for cytopathology education: A review and approach

Clinical training imposes time and resource constraints on educators and learners, making it difficult to provide and absorb meaningful instruction. Additionally, innovative and personalized education has become an expectation of adult learners. Fortunately, the development of web‐based educational tools provides a possible solution to these challenges. Within this review, we introduce the utility of adaptive eLearning platforms in pathology education. In addition to a review of the current literature, we provide the reader with a suggested approach for module creation, as well as a critical assessment of an available platform, based on our experience in creating adaptive eLearning modules for teaching basic concepts in gynecologic cytopathology. Diagn. Cytopathol. 2016;44:944–951. © 2016 Wiley Periodicals, Inc.