Feature
Anatomy lessons
(Illustration: Henrik Drescher)
Students discover patient care at the heart of the anatomy lab
By Jack El-Hai
First-year medical students contemplate a photocopied letter posted outside the gross anatomy labs of the University of Minnesota Medical School. The letter is from an anatomical donor who describes her upbringing on a farm, her thwarted ambition to become a dietitian, her dark time in an abusive marriage, and her final days as a great-grandmother and activities leader at a senior center. “My life was good,” she concludes her letter, “and I’m glad to help you in your studies to help make other lives better.”
The letter offers context: the life lived by an anatomical donor and her hopes for her generous gift of her body. Today when gross anatomy students learn from donated bodies, they know the donors’ full medical histories. And their coursework involves more than the dissections and the memorization of body systems that have been a part of medical education for centuries.
Human geography
“Anatomy is human geography,” says Tony Weinhaus, Ph.D., director of the Program in Human Anatomy Education at the Medical School, and under his guidance it is evolving into a gateway to clinical fluency and professionalism.
Gross anatomy, typically the first course that new medical students undertake, stands out as a watershed moment for many physicians. “[Few of these students] have seen an anatomical specimen before—it’s a completely new experience,” says John Raskind, M.D., an orthopaedic surgeon and adjunct associate professor in the Medical School who works with anatomy students. “To many, it’s overwhelming. Not everyone loves anatomy, but if you become a surgeon, you probably really liked it.”
Jennifer Moy, a first-year student who took gross anatomy in the fall of 2008, agrees that anatomy excites future physicians of a particular kind. “I’m hands-on and visual,” she says. “Having real anatomical specimens available to touch and see helped my learning immensely. The relationships between different systems of the body are right before your eyes.”
The clinical context
Weinhaus, an expert on anatomy education and the ways students learn in the anatomy lab, uses clinical physicians like Raskind to stress the field’s practical applications. “Often gross anatomy is taught without explaining why or putting it in a clinical context,” he says. In contrast, “when we start, all of the written exams are cast as patient vignettes. We put those vignettes in the lectures. M.D.s come to talk about the use of anatomy in their field.”
Raskind, for example, tells students how anatomical knowledge directly guides the orthopaedic treatments he gives patients. “In my practice, clinical anatomy is my life,” he says. “If I’m looking at a shoulder x-ray and there’s a fracture of the proximal humerus, I’m visualizing the anatomy in that area—all of the muscles and tendons involved—which helps explain the fracture displacement pattern and also helps determine the treatment.”
For students to make these connections between study and practice, working with the human body is crucial. “Structures don’t always appear the way they look in a book,” Weinhaus says. “An artery may not be where the book says, because there’s a lot of anatomical variation among people.”
Students initially study anatomical dissections that others perform, but they soon move on to their own dissections and even CT scans of the human body. Some other schools make extensive use of computer simulations of the body in the laboratory. Weinhaus believes that three-dimensional simulations are effective primarily as lecturing aids because they save time, but they can’t replace the real thing.
“Learning is highly tactile,” agrees Kathleen Watson, M.D., the Medical School’s associate dean for students and student learning. “You have to see, understand, and touch to comprehend three-dimensional systems. That’s the gap we face with simulations.”
Structure and function
Anatomical donations have their limitations, too. “They give you an idea of the spatial relationships in the body, but just because you can see a structure in a cadaver doesn’t mean you can palpate it in a patient,” Weinhaus notes.
That’s why anatomy students have an opportunity to test what they have learned in the lab and gain examining skills with living subjects (one another at first) in the Interprofessional Education and Resource Center (IERC), which provides facilities and services—including simulated situations—to develop and assess students’ clinical skills. The IERC’s riches in simulation technology—including such valuable tools as the CathSim and the SimMan—are now primarily used not by gross anatomy students, but by more advanced medical students, biomedical device designers, and students in nursing and other fields.
Professor of family medicine and community health Sharon Allen, M.D., Ph.D., who directs the Medical School’s Physician and Patient course, has partnered with the IERC to provide students with opportunities to examine the ankles, knees, elbows, and hips of the living to reinforce anatomical studies of the deceased. The center recently has added sessions on the cardiac and pulmonary systems as well as the cranial nerves.
“This is how we put structure and function together, by teaching the clinical exam right along with anatomy,” Allen says. “Students love it, and it gives relevance to what they learn in anatomy.”
While learning with anatomical donations and then living people, students start to develop the professional behaviors they will need as working physicians. “The study of gross anatomy requires students to change their approach—they’re on the road to becoming professionals,” Weinhaus says. “They’re working with a dead body for the first time. They need to cross into a new realm. It can be stressful, and they’re working in a difficult environment, but you have to work with your colleagues and maintain a professional attitude throughout. They could goof around and be macabre, but they don’t because they’re professionals.”
While older approaches to the teaching of anatomy certainly gave medical students valuable skills, they focused on teaching the structural relationships of different parts of the body.
“We missed some opportunities 30 years ago,” Watson says. Gaining professionalism and learning how to treat patients respectfully during examinations have always been on students’ minds, but today’s anatomy curriculum actively includes them. “There’s a huge part of the culture of medicine that we’re now making more explicit,” she says. At the University, the centuries-old study of anatomy continues to acquire new depth.
