INTRODUCTORY REMARKS REGARDING HUMAN GROSS ANATOMY
Welcome to Human 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 will also 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. 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. In this course you will explore anatomy in the lab directly and actively so you can build your own knowledge of human anatomy. Many students consider the chance to directly explore human anatomy a watershed moment in their medical education.
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 work together in a team to respectfully and carefully dissect a human cadaver, and you will 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.
We have a staff of eight faculty (all with advanced degrees in anatomy-related fields) and two graduate student teaching assistants who will work with you in lecture and lab. All the members of the Gross Anatomy Teaching Group are available to you. While we don’t hold formal office hours, we are happy to talk before or after lecture or before, during, and after lab. We can also meet with you in our offices or somewhere on campus. 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 you need. Gross Anatomy is our priority when the course is in session.
LECTURES AND TEAM-BASED EXERCISES
Lectures: There are 27 lecture slots in this course held in the Learning Hall 2050. You can find lecture slots and team-based exercises (TBE) listed on Bluedocs and the Online Dissector. Most of those slots are dedicated to specific didactic-style lectures (~50 min total) but some of those will be taught in concert with a clinician (~80 min total).
Attendance 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 we hope you will attend as many as possible. We can minimize the simple we-talk-you-listen mode easily and allow the lectures to meet your needs. Before the lecture you will be provided with a short “tutorial” and/or prepared lecture notes. You should read these materials before class and the pages in the textbook so you come to the lecture prepared to ask questions. You can then ask questions and drive the discussion. We will be prepared to cover topics of any relevance to the material being covered even if it is a detour from planned lecture. Those kinds of deviations following questions and discussion are what makes lecture attendance valuable compared to streaming.
Critical thinking and research are a key component of the medical education program at Duke. This philosophy of scholarship pervades all aspects of the program and is consistent with a focus on evidence-based medicine that relies on peer-review primary research to guide clinical practice. To promote that approach to thinking and understanding at the earliest opportunity, we use peer-reviewed literature as part of our anatomy course. For many of the lecture topics we will provide one article to be read before class (posted on Bluedocs). At the end of the lecture associated with that article, the lecturer will promote a graduate-level discussion of the issues. Ideas that will be discussed include the relevance of the research, the validity of the research, and the larger implications for clinical practice and future research. The lecturer will call on students to provide their opinions and critiques. There are no grade points associated with this article discussion. This is simply an opportunity for you to have direct experience with graduate-level discussions of research. It will help prepare you for clinical experiences and for your third year research. This event should be fun and interesting. It is also the case that one question, based on each article provided, will appear on the exam for that section of the course.
There are also eight lectures devoted specifically to embryology. Embryology is part of the Gross Anatomy component of the Normal Body. These lectures are very important in developing an understanding of anatomy that can form a useful basis for clinical practice. Please attend these. Questions about embryology will be included on all GA exams. 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.
Team-based Exercises: Five Gross Anatomy and at least two Embryology lecture slots will be dedicated to a TBE style using group assessments, team applications, or group-learning with osteological material. TBE attendance is mandatory. In most cases, the TBEs will be in the Learning Hall in your anatomy table groups.
HUMAN GROSS ANATOMY LABORATORY
Labs: There are 27 labs in this course, which are primarily held in DS 042 PZ. You will be assigned as a team to a single cadaver (group information is posted on Bluedocs and the Gross Anatomy lab website). You will aslo be organized into sections in the lab, with each section containing two to three faculty and one graduate student TA. The instructors and TA are part of your team and they are there to help. However, instructors will not dissect for you except in cases where pathology has made the work more challenging than it might otherwise be. Ask questions, explore, work together, and mainly be curious.
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. Tools for dissection are available at the book store. You will need to buy one dissecting kit. An additional kit has been donated to each table from students in previous years (available in the lab along with a few extra tools).
Lab Talks: During most labs, half of your team attends a short 20 minute “lab talk” (a mini-lecture with opportunities for direct question and answer with one of our instructors) in a small lecture room near the lab (DS 101A). The same lecture will then 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. The room for these talks is small and can get noisy easily. Please be respectful to your fellow students and all presenters by arriving on time and refraining from talking.
ONLINE DISSECTION MANUAL
To guide your dissections, you will follow an online dissection manual.
The dissection manual consists of the following parts:
The dissection manual consists of the following: (1) objectives and goals, (2) procedures, (3) functional context, (4) clinical context, (5) dissection hints, (6) relevant images, (7) clinical correlates, and (8) surface anatomy. Sometimes there are optional dissections, but these should be read and studied for exams. If time permits, you should take the opportunity to carry them out on your cadaver. Also, there are many options to look at radiological images and cross sectional anatomy, both of which are an important component of Gross Anatomy and are testable material. Additional information is provided on the How To Use the Dissector page.
THE MECHANICS OF DISSECTION
Before coming to the laboratory, read the relevant sections in your textbook and in the 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 understand the general developmental history of the structures in this region, and of the way in which blood supply and innervation reach them. (This last point 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.
All students are expected to read the dissector prior to attending lab and must be prepared to perform the day’s dissection. However, in the interest of fostering teamwork and leadership skills, as well as streamlining the dissections, each cadaver team will designate a daily “Dissection Captain.”
The daily Dissection Captain is responsible for: 1) Reading the dissector ahead of lab and coming prepared to perform the dissection; 2) Leading their team through the dissection and delineate tasks; 3) Leading a review of the major structures explored following each dissection; 4) Making sure the dissection instruments are accounted for, organized, and cleaned following each dissection; 5) Making sure the cadaver is wetted and properly stored following each dissection; and 6) Making sure your station is clean, the light is turned off, and you have logged off the computer.
Prior to the first dissection, each cadaver team will produce a schedule of daily Dissection Captains to be approved by the anatomy teaching staff. Dissection Captain assignments should be evenly distributed among all the team members. Each team member must take a turn as Dissection Captain prior to any member taking a second turn. Your performance as Dissection Captain will be included in the review of your professionalism across the Normal Body course.
Our web page for this course is a critical source of information (http://www.duke.edu/web/anatomy/) and it contains: (1) course information, (2) table assignments, (3) faculty information, (4) detailed reading list, (5) cross-sectional images, (6) video resources, (7) terminology references, and (8) links to other courses. All of these will be valuable to you.
Each student must purchase: Gray’s Anatomy for Students 3rd Edition by Drake et al., Elsevier, 2015 ed.
Each lab team must purchase: Grant’s Atlas of Anatomy by A.M.R. Augur, 13th edition.
*Any recent edition of the textbooks is fine. We have listed the most recent versions.
-Anatomy: A Regional Atlas of the Human Body by C.D. Clemente, 6th edition
-Atlas of Human Anatomy by F.H. Netter, 2nd edition
-Color Atlas of Anatomy by Rohen et al., 7th edition
-A.D.A.M. Student Atlas Of Anatomy by Olson, 2nd edition
-Thieme Atlas of Anatomy by Gilroy et al., 2nd edition
Langman's Medical Embryology, 13th ed. by T.W. Sadler (2015). Lippincott Williams & Wilkins.
Lecture Exams: There are four lecture exams. These will be taken via computer (through Examsoft), but students will take the exams in the Trent Semans Center, during the time period specified on Bluedocs. The exams will contain factual and conceptual questions in multiple formats including ordering, labeling, fill-ins, true/false, and multiple choice/multiple correct. The exams will also have between 1/3 and 1/2 “board-style” questions. These exams include embryology questions explicitly and 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 obtain permission from the advisory Dean and Course Director to do so. Exams can only be retaken in the case of failure once. Each exam will be worth 12% of the grade. Thus lecture exams will constitute 48% of the grade for GA. These exams are not explicitly cumulative.
Laboratory Practicals: There are three laboratory practical exams associated with Exams 2, 3, and 4. These are taken in lab. Lab practicals last for 30 minutes and are held at two separate times in two groups before the lecture exam. You will be assigned to a group for each practical. You will be assigned a time to begin, and a station at which you will start. Arrive at least five minutes early so the practical can start on time. If you are late for the practical, you will lose the points for every question you were not in attendance for, unless you have an excused absence. 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). 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 once. Each practical will count for 12% of the grade, for a total of 36% of the GA grade.
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 student has to complete a make-up exam, we sometimes delay release until it 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. Following the Normal Body Policy we do not provide keys for exams that can be kept or distributed.
Lab Attendance: Lab attendance is mandatory and counts for 6% of your final grade. 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 . If you miss more than 4 labs without excuse you will have 6% deducted from your grade. This rule is designed to make sure you really spend time dissecting and that you do not leave your team short-handed for this enormous task.
Team-based Exercises: Team-based exercises are mandatory and participation in them constitutes 10% of your grade. 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 the absence is excused 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. You should only miss these sessions for very serious reasons.