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. A video about the lab will be available on the web page (https://web.duke.edu/anatomy/Lab01/Lab1.html, step 1). This video contains key information you will want to have before starting this course.
- 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.
- Each lab group must also buy one copy of Grant’s Atlas by A.M.R. Augur, 13th edition for use in the lab. You can chip in to buy one together.
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.
- 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 (https://web.duke.edu/anatomy/Lab01/Lab1.html, step 1). 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. There may also be tools available in the labs that have been specifically left for you by the previous class.
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 faculty (holding advanced degrees in anatomy-related fields) and one graduate student 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.
- Pre-lab Quizzes: Before each lab you will be required to answer a set of pre-lab questions on Bluedocs. These short pre-lab quizzes are designed to make sure you are prepared to proceed with the assigned lab. We don’t grade these but we do record that they are completed. These are important for you and ourselves because it helps make sure that you are prepared for lab and can make the most of this unique experience. If you miss more than 4 labs and fail to complete more than 4 pre-lab question sets without excuse you will have 6% deducted from your grade. Taken together with practical exams, laboratory-based knowledge and activities constitute 42% of the total GA grade.
- 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. These are separate from pre-lab quizzes administered through Bluedocs. You need both.
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.
OVERALL COURSE INFORMATION
Welcome to Human Gross Anatomy. We hope you find this to be a useful course as you develop as clinicians. Many students consider the chance to directly explore human anatomy a watershed moment in their curriculum. That means it can be both awesome and challenging. We have designed this course to try to make it as manageable for you as possible while not diminishing any of the experience or content. We are always available for questions or to help you in any way we can. Don’t hesitate to contact me or any of the teaching staff for Gross Anatomy.
This course is designed to integrate with the other courses in the Normal Body and provide you with gross anatomical knowledge that fits with the concepts being explored in Physiology and Microanatomy. Although we do not construct our courses around clinical principles (this is the “Normal” body after all), we are dedicated to helping develop gross anatomical knowledge as a basis for clinical practice. We also want to help you prepare for the critical exams you face in your career. Most importantly, of course, we want be an effective part of the process of preparing you to become doctors. We believe that the best way to do this is to work with you to help you understand gross anatomy as a basic science and the use of its principles for understanding and solving clinical problems. We also want you to be able to explore anatomy in the lab directly and actively so you can build your own knowledge of human anatomy.
To meet these goals we have a variety of educational opportunities and resources for you. We also have a staff of eight faculty (all with advanced degrees in anatomy-related fields) and three graduate student teaching assistants who will be working with you in lecture and lab. The details of all of our resources and requirements including schedule, textbooks, grading etc. are provided in the lengthy document below as well as other resources (see our resource page: http://www.duke.edu/web/anatomy/) . But, I know there are pressing issues on your mind. So I will summarize the most important points below and then you can read all the details in the pages that follow.
- Lectures/GRAs & applications: Lecture slots and team-based events (TBE) are listed on Bluedocs and http://www.duke.edu/web/anatomy/. Attendance at didactic lectures is not mandatory but you are strongly encouraged to attend and participate. This is something we all feel strongly about. Direct student-faculty interaction is key to learning in any class, and especially so in a class like anatomy. We can’t teach you every detail of anatomy, so we want to work together to develop key concepts and principles for solving problems with anatomical information. The active exchange between faculty and students is critical to that kind of education. Scheduled TBE events in the lecture hall and lab, however, are mandatory and included in your grade.
- Labs: You will be assigned, with five other students, to a single cadaver (group information is posted on Bluedocs and http://www.duke.edu/web/anatomy/). Your group will get to do all the dissection. Instructors will not dissect for you except in cases where pathology has made the work more challenging than it might otherwise be. This is a unique team-based experience so attendance is mandatory. There are options for excused absences (see policy below). There are no specific clothing requirements except that you must wear long pants and closed-toe shoes. Shorts and sandals are unacceptable. We have a video about lab procedure available at http://www.duke.edu/web/anatomy/. Tools for dissection are available at the book store. You will need two dissecting kits (and maybe a couple of extra scalpel handles) per group. Some tools donated from students in previous years will be available in the lab.
- Books: You must each purchase one copy of the required textbook (Gray’s Anatomy for Students 2nd Edition by Drake et al., Elsevier, 2010 ed,). You must purchase, as a group, one copy of Grant’s Atlas (by A.M.R. Augur, 13th edition) to be used in the lab. You will buy this with your group and you can all chip in. There are several other optional texts. The dissector for this lab is written for this course and is available online (http://www.duke.edu/web/anatomy/).
- Grading: Grades are based on four written exams, three practical exams, lab attendance, and TBE activities. The percentages and details are included below.
There are 28 lecture slots in this course. Most of those slots are dedicated to specific didactic-style lectures from the course director. Some of those will be taught in concert with a clinician. Most lectures are 50 minutes. But some have the option of lasting 80 minutes. A full 80 minutes will only be utilized if needed when additional clinical lecturers are speaking.
Attendance at the didactic-expository lectures (classic lecture style where I talk and you listen and ask question and we discuss the issues associated with the topic of the day) is not mandatory but you are very strongly encouraged to attend. Direct contact between lecturer and student improves the lecture itself and provides opportunity for discussion and questions that extend the lecture into important areas. So I hope you will attend as many as possible. We can minimize the simple I-talk-you-listen mode easily and allow the lectures to meet your needs. Before the lecture you will be provided with a short Powerpoint “tutorial” and/or prepared lecture notes (see resources below). You should read these materials before class and the pages in the textbook (see resources below and detailed schedule) so you come to the lecture prepared to ask questions. You can then ask questions and drive the discussion. I will be prepared to cover topics of any relevance to the material being covered even if it is a detour from my planned lecture. Those kinds of deviations following questions and discussion are what makes lecture attendance valuable compared to streaming.
There are also at least six lectures devoted specifically to embryology. Embryology is part of the Gross Anatomy component of the Normal Body. These lectures are very important to you developing an understanding anatomy that can form a useful basis for clinical practice. Please attend these. Questions about embryology will be included on all GA exams (see below). The primary lecturer for embryology—Dr. Velkey—will provide specifics about his expectations for each lecture or TBE, though you can also ask questions about the material to the course director or any of the teaching faculty.
At least six of the lecture slots will be dedicated to a TBE style using group assessments or team applications or group-learning with osteological material. Those will be mandatory. TBE will be done in most cases in the amphitheater in your anatomy table groups or in learning studios in TSCH in your anatomy table groups.
Labs (see above for details):
The lab is the biggest and most important part of this course. There is a lot to know about the laboratory component. The information about the lab is included in at least three places: (1) a document called “general remarks on dissection and textbooks” included as a separate document with this one, (2) the same document on bluedocs in several places, (3) the same information is on our web site (http://www.duke.edu/web/anatomy/) under “Course Information”. I won’t repeat them here. Please consult that document. There is also a video designed to help you prepare for lab that is listed under the first day of lab on our website (http://www.duke.edu/web/anatomy/).
Please remember you must buy a couple dissecting tool kits for your table (you can also chip in together), one copy of Grant’s Atlas for your table (you can all chip in together), and wear long pants and closed-toed shoes to lab. Equally important is the respect and reverence to which we approach dissection, something that we will discuss together and that is detailed in the documents I mentioned above.
There is one required textbook for this course. You must obtain Gray’s Anatomy for Students 2nd Edition by Drake et al., Elsevier, 2010 ed,).
We also recommend:
Anatomy: A Regional Atlas of the Human Body by C.D. Clemente, 4th edition
Atlas of Human Anatomy by F.H. Netter, 2nd edition
Color Atlas of Anatomy by Rohen et al., 4th edition
A.D.A.M. Student Atlas Of Anatomy by Olson
Thieme Atlas of Anatomy by Gilroy et al.
Each lab team must buy one copy of Grant’s Atlas of Anatomy by A.M.R. Augur, 13th edition.
The Embryology Lectures in Gross Anatomy are presented by Matt Velkey. He recommends the following textbook: Langman's Medical Embryology, 12th ed. by T.W. Sadler (2009). Lippincott Williams & Wilkins. I SBN-10: 1451113420 ISBN-13: 978-145111342
Our web page for this course is a critical source of information and resources. The page is: http://www.duke.edu/web/anatomy/information.html. That page contains (1) course information, (2) table assignments, (3) faculty information, (4) detailed reading list, (5) cross-sectional anatomy, (6) video resources, (7) a glossary, (8) links to other courses in the program. All of these will be valuable to you.
Of course you may find lecture material, pre-lecture tutorials, pre-lab tutorials, and lecture notes helpful as well. We also provide a Human Gross Anatomy Laboratory Companion/Study Guide. This guide simply presents case-based questions (and answers) that you can use to guide your studying. We hope that you will use this Guide in the lab when you come into study off-hours. It is designed to be used with a cadaver. But, of course, it can be useful when not in the lab and when used in conjunction with an anatomical atlas.
It is easy to get overwhelmed by all these resources. You do not have to look at them all. Some are required and some are suggestions. The optional resources won’t help everybody. We provide resources for students engaged in any learning style. We do not recommend you use them all. Instead, test them out and use the resources that work best for you. The primary resources are lecture/TBE material, online dissector, and textbook.
All the members of the Gross Anatomy Teaching Group are also available to you. We don’t hold formal office hours. But we are happy to talk after lecture or before, during, and after lab. We can also meet with you in our offices or somewhere on campus. All of us will answer email as promptly as possible. Remember that although most of us are active researchers, we will make the time to talk with you or meet with you as much as we need. Gross Anatomy is our priority when the course is in session.
- Written Exams: Four written exams (48%): These will be on computer (through Bluedocs) but students will gather in the locations used for all written exams in Normal Body. During the time period specified on Bluedocs. The exams will contain factual and conceptual questions in multiple format including “ordering”, “labeling”, “fill-ins” of various sorts, True/False, and multiple choice/multiple correct (all these consistent with past exams. The exams will also have between one-third and one-half “board-style” questions. These exams include embryology questions explicitly and embryology concepts within other questions. Students must get a 60% or greater on any exam to pass. Retake exams for missing or failure are given based on the specific written policy that guides students to get permission from the advisory Dean and Course Director to do so. Exams can only be retaken in the case of failure one time. Each exam will be worth 12% of the grade. Thus written exams will constitute 48% of the grade for GA. These exams are not explicitly cumulative.
- Laboratory Practicals: Three laboratory practical exams (36%) associated with exam 2, 3, and 4. These are taken in lab. Lab practicals last for thirty minutes and are held in two groups after the exam. You will be assigned to a group as you finish the written portion of exams 2 - 4. 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). They will count for 12% of the grade for a total of 36% of the GA grade. Students must get a 60% or greater on any exam to pass. Retake exams for missing or failure are given based on the specific written policy that guides students to get permission from the advisory Dean and Course Director to do so. Exams can only be retaken in the case of failure one time.
Lab Attendance: Lab attendance and completion of pre-lab questions is mandatory and counts for 6% of your final grade. There are 26 labs. Students must attend 85% of the labs. More specifically, you can miss 4 labs without an excuse. If you have reached that number and need to miss for illness or emergency please speak to the course director and you may be excused and the absence will not count against you. Before each lab you will be required to answer a set of pre-lab questions on Bluedocs. These short pre-lab quizzes are designed to make sure you are prepared to proceed with the assigned lab. We don’t grade these but we do record that they are completed. These are important for you and ourselves because it helps make sure that you are prepared for lab and can make the most of this unique experience. If you miss more than 4 labs and fail to complete more than 4 pre-lab question sets without excuse you will have 6% deducted from your grade. Taken together with practical exams, laboratory-based knowledge and activities constitute 42% of the total GA grade.
Team Exercises: Team-Based exercises are mandatory and participation in them constitutes10% of your grade. These are all mandatory. Completion of these exercises is the requirement to gain the points. We follow the policy established for the Normal Body Course in which any unexcused absence will result in a score of zero. If I excuse the absence ahead of time the TBE scores will be calculated based on the sessions that the student attended. Team-based events aren’t recorded and can’t be completed at a later date. So you should only miss these sessions for very serious reasons.
- There are always questions about exam release and key release. In regards to the former we grade some parts of the exams by hand and usually require a day to do so. If a students has to complete a make-up exam we sometime delay release until that has been completed. In regards to key release we follow the policy established for the Normal Body Course of allowing short-term review of the key after exams. Please note that you have a resource DVD with past questions including last year’s exams. Following the Normal Body Policy, starting this year we will not provide keys for exams for that resource DVD. That is to say, you will have access to old GA exams up to 2012. If there is any major change in style or process I will provide model questions to illustrate any new approach. But it is our intention to continue to use a mix of multiple choice/multiple correct questions, USMLE/STEP 1/Single correct questions, image-based questions, ordering/pathway questions, and short answer question as we have done to varying degrees since the course was first established.