INTRODUCTORY REMARKS REGARDING HUMAN GROSS ANATOMY
What follows contains a number of remarks relevant to lab. There are a lot of details here, but for convenience you will also find the necessary information for commencing your study of anatomy summarized immediately below. An introductory video about the lab will be available on the webpage for Lab 1.
- You have been assigned a cadaver and been placed in a team of six people working together. Your table number and room section are now available in separate documents posted on our site and Bluedocs. You will have specific instructors who will work with the students in your section the whole year.
- You are expected to own copies of Gray’s Anatomy for Students, 2nd Edition by Drake et al., Elsevier, 2010.
Each lab group must also buy one copy of Grant’s Atlas by A.M.R. Augur, 13th edition for use in the lab.
Atlas images will be available via the online dissector, but we also think you should have at least one commercial atlas with all its details and text in a hardcopy form for use outside of lab. You won’t regret it. We recommend you purchase one of the following anatomical atlases:
- Anatomy: A Regional Atlas of the Human Body by C.D. Clemente, 4th edition
- Atlas of Human Anatomy by F.H. Netter, 5th edition
- Color Atlas of Anatomy: A Photographic Study of the Human Body by Rohen et al., 7th edition
- A.D.A.M. Student Atlas Of Anatomy by Olson
- Thieme Atlas of Anatomy by Gilroy et al, 2nd edition.
The Embryology component is directed by Dr. Matt Velkey. He recommends the following textbook: Langman's Medical Embryology, 12th ed. by T.W. Sadler (2012). Lippincott Williams & Wilkins. ISBN: 0781790697
- There are many important aspects of lab behavior for safety and ethics that are included in separate documents on the web site and Bluedocs and in our video. We will review those with you. But here are some key things to know before you can come to lab:
- You can wear street clothes or scrubs or ratty old clothes but you MUST wear a shirt, long pants and closed-toe shoes at all times. We will provide gloves and aprons and masks (if you want one).
- Each 6 person team will need to purchase two complete dissecting kits with scalpel handles, toothed forceps, dissecting needles, and blunt probes for your group (you just need to buy two so you can split the costs). They are available in the bookstore.
GENERAL REMARKS ON THE LABORATORY COMPONENT OF HUMAN GROSS ANATOMY
You, as a beginning student of human anatomy, are about to undertake a fascinating investigation of a system of natural phenomena. This is a seminal event for most students and it is worth taking some time for comments on the philosophy and mechanics of this project. You will hear lectures and work on problems in Gross Anatomy. This area of study (along with the other components of the Normal Body course) focuses on the integration of the parts of the human body into a working whole. You will also be given the body of a dead human being, and you will respectfully and carefully dissect it and attempt to learn something about the workings and arrangement of its various parts.
We cannot emphasize too strongly that the object of your laboratory work is not just to find all the structures mentioned in the dissection instructions, but to understand what you see. The first question you should ask when you dissect a new region is "What is this?” not "Where is it?" Having answered this first question, you should then ask, "What does it do?", “How does it do it?”, “Why does it do it?” and "How did this get to be the way it is?" Identifying structures is not the goal of this class or of our dissection; it is only a necessary first step. The goal, as in all other kinds of scientific investigations, is to make sense out of what you see.
Our goal is to help you find the answers to these questions so you can develop the key knowledge of anatomy you need for your career. We are there to help and we will help a lot. But we can’t and shouldn’t do the dissection for you. The process of exploring the human cadaver as an individual and as part of a team is a key part of this process. In addition, Gross Anatomy is a fully integrated part of the Normal Body Course. The answers to the questions of “what does it do?’, “How does it do it?”, “Why does it do it?” and "How did this get to be the way it is?" can be answered only by information found in Gross Anatomy, Microanatomy, Physiology, and Embryology. In this laboratory you will integrate all the things you are learning in all parts of the course. Our “Lab Challenges” at the beginning of the lab, in-lab tutorials during the lab, and “Group Readiness Assessment” at the end of lab are all designed to explore those areas of integration whenever possible.
You will be divided into teams. Five teams will be organized into a section of the lab and you will have two instructors and one TA available to you area during all lab hours. The instructors and TA are part of your team and they are there to help. Please utilize them during lab. Ask questions, explore, work together, and mainly be curious. The knowledge you get in this lab will come into play many times in your career.
THE MECHANICS OF DISSECTION
Most of the structures of the body have differentiated largely or wholly out of mesoderm, and they remain separated by thin layers of fascia--relatively unorganized mesodermal connective tissue. It follows that dissection is largely a matter of separating one structure from another along these fascial planes, using a blunt instrument. The most useful dissecting instruments are your fingers. This cannot be emphasized enough. Edged instruments--needles, knives, and scissors--are for use on structures too tough or too delicate to yield to blunt dissection.
A good plan to follow when dissecting:
Before transecting any structure, separate it from underlying tissues by blunt dissection, then insert an edged instrument underneath it and cut upwards. Scissors are generally more useful than knives. Try not to be finicky or over-meticulous in dissecting; more can be learned from a clean straight cut through a structure than from a surface that has been mangled by repeated cleaning attempts. When cutting and reflecting multiple parallel structures--e.g., the forearm flexor muscles--cut each one at a different point to facilitate replacement.
When you dissect, keep a couple of paper towels handy to receive detritus. Finally, make sure that all parts of the cadaver are kept well-moistened with water or preservative solution. This is particularly crucial in the head and the extremities. At the end of the each dissection period, replace the reflected structures in their proper positions and drape the wrappings over the cadaver. Moisten the gauze covering the cadaver thoroughly with preservative before you wrap the plastic sheet tightly around the cadaver--and be sure to keep the head and extremities well-moistened and tightly covered.
We will provide more information on procedures and tools on the first day of class. Instructors will demonstrate techniques during the first lab.
DISSECTION AND STUDY PROCEDURES
You will profit most from a dissection if you know what to expect before you dissect a region, can identify what you see in the process of dissecting, and are able to relate what you have seen to your general organizational and functional understanding of the human body. We suggest the following procedure:
1. Before coming to the laboratory, read the relevant sections in your textbook and in this dissection manual. Study the drawings in your atlas of the region to be dissected. Read any specific pre-lab material provided. Make sure that you have some fairly clear idea of the general developmental history of the structures in this region, and of the way in which blood supply and innervation reach them. (This last is emphatically not the same thing as memorizing a list of paired anatomical names. This is really about making connections between anatomical parts that must work together and connecting that to what you are learning in other parts of this course). In short, please come as prepared as possible.
2. Consult an articulated skeleton before beginning dissection (you may be asked to consult osteological material from your bone box or the model room before lab as well) -- orient yourself and locate important landmarks on the bones. Your team will receive a bone box for use at home. We also have an extensive bone collection in the “model room” and articulated skeletons throughout the lab. Ask your instructor to guide you on some of the key landmarks on the skeleton for the day’s dissection.
3. Learn the terminology. Anatomical terminology can be a stumbling block Whenever possible, learn what components within the terms mean -- as in Triceps brachii muscle -- the three (Tri-)-headed (-ceps) muscle in the arm (brachii). Since there have been two major and several minor overhauls of the nomina anatomica since 1930, you may learn several alternative names for some structures. Older literature, older faculty, and comparative anatomists are going to go on retaining some of these older alternatives indefinitely. See the guide to anatomical terminology in the header of the webpages.
4. In dissecting and in reading, try to associate each structure you encounter with the largest structural and functional groups to which it belongs, and try to apprehend its peculiarities as a series of deviations from these general patterns. Thus, the Semimembranosus (at the back of the thigh) represents a variant of the general arrangement of the hamstring muscles (a muscle group many people know form tearing them); the hamstrings represent a variant of the general group of flexor muscles of the leg (they can flex your knee), which developed from the developmentally dorsal muscles of the developing limb; this is a specialization of the body-wall musculature, which in tum is developed from the hypaxial musculature, which arises from the myotome of the embryonic body segment. That sounds long and complicated but it actually helps make sense of what you see from a functional and developmental perspective. In this context, facts about origin, insertion, action, innervation, blood supply, and lymphatic drainage are more easily learned and retained far longer. When you have some knowledge of the structural logic of the human body, you can infer vast numbers of details from a few central facts. This is invaluable in guiding your dissection and organizing your reading.
5. Explore multiple ways of learning to find what works best for you and get different perspectives. Different people learn more easily in different ways; some students of anatomy will find pictorial material most useful, while others will rely on verbal descriptions, discoveries on the dissecting table, or impromptu lectures in the laboratory. Probably the best way to learn any large body of material is to try to explain it to someone else; you will benefit from searching out answers to questions raised by your partners in the laboratory. Anatomy lab is by definition a team-based exercise. Take advantage of that and learn with and from each other.
LAB GRADING AND IN-LAB TEACHING AND TESTING OPPORTUNITIES
It will sound corny to you now, but we really believe that human dissection is a rare and special opportunity and our only goal is for you to learn anatomy. So everything we are doing (organizing you into sections with specific instructors, online dissectors and images, course integration etc.) is designed to help you maximize this once in a lifetime experience. All of our lab teaching and testing has the same goal. Here are some grading/learning issues associated with Gross Anatomy.
- Lab attendance is mandatory: You are required to attend at least 85% of the labs. You may have 4 unexcused absences. In all other cases please speak to the course director. This rule is designed to make sure you really spend time dissecting and that you not leave your time short-handed for this enormous task. This represents 4% of your overall grade. Details on grading are provided in a separate document.
- Group Readiness Assessment: Each lab builds on the previous one. At the end of a block of lab work (i.e. the thorax or lower limb) there will be a brief and mandatory GRA designed to make sure that your group has a reasonable mastery of the lecture and lab material associated with that day’s work. These questions will be thoughtful and designed to test your larger understanding. They are mandatory but not graded. We will review the results with you and clarify any questions. That way we know (and you know) that you are ready to move on to the next section of the dissection.
- In-lab tutorials (“Lab Talks”): We think small group discussions are very helpful and we often want to cover in somewhat more depth some of the anatomical issues of the day. So on some days during lab time we will ask that half of your group attend a short 20 minute tutorial (a kind of mini-lecture with opportunities for direct question and answer with one of our instructors) in a small lecture room near the lab. The same lecture will be repeated to the other half of your group. On those days you will be notified of when those lectures occur. They will generally happen at 3 pm and 4 pm.
- Lab challenges: Students often feel that dissection has no “purpose” (though see above for our thoughts on that). We provide you with a lab challenge each day. This is an overarching question that guides some of your exploration for that day. The lab challenge may connect to the GRA or to the in-lab tutorial. But it may not. It may cover a different aspect of the dissection so as to maximize the different ways to incorporate a larger understanding of the day’s material.
- Lab practical exams: As noted in other documents you will receive, there will be three thirty minute lab practical exams taken after each written exam (but not the quiz). For each practical exam you will have one minute to identify a structure either directly or by identifying a structure that attaches to another one (i.e. muscle to a part of a bone). Each practical exam is 12% of your grade. Details on grading are provided in a separate document.
The online lab manual can be accessed from computers in the lab and at outside of the lab at http://www.duke.edu/web/anatomy/. The lab manual is organized so that you can tell clearly what you should expect to accomplish during each lab period. There is information on how to use the dissection manual (often called the dissector) at the beginning of the manual itself.
The descriptions and instructions contained in the lab manual pertain to normal or common arrangements -- you should expect to find variants or anomalies in your dissection. Common variations in musculature, skeleton, viscera, and major blood vessels are shown in each section of Grant's Atlas. All variations tell you something about human ontogeny; a few have clinical or phylogenetic significance. Be sure to call your instructors' attention to any conspicuous deviation from the norm. Make sure you look at other cadavers in the room, compare and contrast them to yours, and look for pathology, anomaly, and clinical intervention.
The lab manual consists of the following parts:
MAIN TEXT OF DISSECTION MANUAL: The details of how to use the manual are included in the introduction of the manual itself. In short, the main text for each lab provides (1) objectives and goals, (2) procedures, (3) functional context, (4) clinical context, (5) dissection hints (as pop-outs), and (6) relevant images, (7) clinical correlates. Follow the manual the way you would a good cookbook (that has instructions and culinary context) paying attention to both the specific steps and larger functional and a relevance.
PRE-LAB ACTIVITIES: At the beginning of many of the labs, there are pre-lab activities. Sometimes these are just information that will help you contextualize your dissection. Sometimes the activity is focused on osteology and can be completed you’re your bone box or in the model room before lab. Do these before you come to lab.
OPTIONAL DISSECTIONS: These dissections should be read, and the designated illustrations studied. If time permits, you should take the opportunity to carry them out on your specimen.
CROSS-SECTIONAL ANATOMY: This is an important component of Gross Anatomy. Images will be included online to your cadaver with radiological images with a special attention to computed tomography imaging.