Dissection Guide for Human Anatomy;

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DISSECTION GUIDE FOR HUMAN ANATOMY

byDavid A. Morton

A dissertation submitted to the faculty ofThe University ofUtahin partial fulfillment of the requirements for the degree of

Doctor of PhilosophyIn

Anatomy

Department ofNeurobiology and AnatomyThe University of Utah

August 2003


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Copyright David A. Morton 2003All Rights Reserved


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ABSTRACT

Gross anatomy is a core class for first-year nledical and dental students. Over thepast six decades, the number of hours that medical schools devote to gross anatomylectures and laboratories has declined. However, the books used to guide dissection ofthe human body have not been updated to reflect the reduction in course hours.Therefore, medical and dental students are required to dissect a human cadaver from headto toe in a compressed time frame, using dissection guides that are not designed for theshortened and fast-paced courses of today. As a solution to this dilemma, I created theDissection Guide fo r Human Anatomy. My goal was first and foremost to produce apractical dissection guide for human anatomy and not another anatomy textbook or atlas.This was accomplished with sinlple yet effective techniques. Horizontal page format waschosen to display the text and related illustrations on the same page. Illustrations werefocused on being simple to providing only information pertinent to dissection. Numerousrevisions have been made to the dissection guide by the authors and proofreaders at othermedical schools. The dissection guide has course-tested by three consecutive years ofmedical and dental students during the falls between 2000-2002. Outcomes includedincreased efficiency and quality of dissections, as well as less confusion about dissectiongoals. We conclude that the Dissection Guide for Human Anatomy succeeded by helpingmedical and dental students dissect a human cadaver in today's condensed curriculumenvironment.


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To Celine, Jared, Ireland, Gabriel and the Mortonand Templeman families


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TABLE OF CONTENTS

ABSTRACT ... '" .. , .. , .................................... '" ...................................... vACKNOWLEDGMENTS .........................................................................viiChapterI. INTRODUCTION.............. , ... '" ........ , ......... '" ........................,............. 1II. METHODS ....................................................................................... 8III. RESULTS ................" .................................................................... 17IV. DISCUSSION ..................................................................................20APPENDIX: DISSECTION GUIDE FOR HUMAN ANATOMy ..........................25REFERENCES .... ,........................................ '" ............ '" ...... '" ............ 161


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ACKNOWLEDGMENTS

I would like to express my grateful appreciation to the following individuals: Dr. Albertine and Kerry Peterson, for without their experience and countless hours of

volunteered service, this book would not have been possible Dr. Parks for investing time and funds into my potential to write the dissection guide Drs. Albertine, Ash, Schoenwolf, Southerland and Wiggins (members ofmy graduate

committee) for your suggestions and help Drs. Cook, Cottam and Weyrich, Kelley Murphy, Neil Tolley, Rachel Tomeo,

Torrance Meyers, Sentil, Harry, Kenneth "Boll Foreman, Christine Eccles and BrianClothier for their help and suggestions during the past few years

In memory ofDr. L. W. Miltenberger The medical and dental students from the classes of 2003-2006 at the University of

Utah School ofMedicine The giving individuals who donated their bodies for students to gain an understanding

of human anatomy and to marvel at the magnificence of the human body My parents Gordon and Gabriella Morton who taught me to appreciate the miracle of

the human body and my brothers, sister and in-laws (Templeman and Morton) fortheir unending encouragement

My wonderful wife Celine and our children Jared, Ireland and Gabriel ... myinspiration


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INTRODUCTION

Human gross anatomy courses are typically presented as sequential didacticlectures and laboratory dissections in medical and dental schools. The biggest challengetoday for gross anatomy courses results fronl the dramatic reduction in curriculum hoursthat has occurred over the past six decades. The reduction in curriculum hours hasgreatly decreased the time available to students for dissection of an entire cadaver. Incompounding this problem, the current dissection manuals have not been revised tomatch the reduction in course hours. The present dissertation was designed, therefore, tocreate a dissection guide for human anatomy that fits the current gross anatomycurriculum at the University of Utah School ofMedicine.

Human gross anatomy is one of the required core classes taken by first-yearmedical students. Gross anatomy provides the foundation for understanding the make upof the human body. It is prerequisite to understanding other basic medical classes(embryology, histology, physiology, pathology, etc.) and to the practice ofmedicine.However, during the past six decades, the number of hours devoted by medical schools to

human gross anatomy lectures and laboratories has declined. In 1939, medical schools inthe United States and Canada devoted approximately 338 hours for gross anatomylectures and laboratories (Eldred and Eldred, 1961). By 1955, the average number ofhours slightly declined to 330 hours (Eldred and Eldred, 1961). Course hours declinedprecipitously to 290 hours by 1966, 197 hours by 1973 (Blevins and Cahill, 1973) and182 hours by 1991 (Collins et ai., 1994). In the year 2002, the average total course hours


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for gross anatomy in medical schools was 167 hours (Drake, Lowrie and Prewitt, 2002).At the University of Utah School ofMedicine, curriculum hours fall short of the nationalaverage, being 137 hours for the gross anatomy course. The decline in the number ofhours dedicated to gross anatomy seems to be attributed to the dramatic advances in cellbiology, microbiology, physiology and phannacokinetics and the instructional hours thatmust be devoted to these subjects (Drake, Lowrie and Prewitt, 2002). Another factor thatnlay playa part in this decline is incorporation of different approaches to education, suchas more small group learning, problem based leanling, and increased use of computerassisted learning strategies (Drake, 1998; Giffin and Drake, 2000). Despite the dramaticdecline, students are still expected to dissect an entire cadaver in what is now a drasticallya reduced period of time.

Prior to the 1997-98 academic year, the gross anatomy course at the University ofUtah School ofMedicine was taught during a seven-month period, from September (firstweek) to March (last week). Since the 1997-1998 academic year, our gross anatomycourse has been taught during a four-month period, from August (fourth week) toDecember (first week). In addition to gross anatomy, medical students at the UniversityofUtah School ofMedicine take histology, medical embryology, psychiatry, art ofmedicine, and community patient courses between September and mid December.Students are encouraged do well in gross anatomy because a lack of understanding inanatomy may affect their futures as physicians since medicine is grounded on anunderstanding of the human body. However, the students' attention is diverted byconlpeting courses that are taught during a short period.


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Many of the current commercial dissection manuals were written years ago whentime available for gross anatomy exceeded 200 hours. Although many of the currentdissection manuals have been revised since their first edition, they are not designed todirect efficient dissection in today's truncated curriculum time frame. The main problemwith most of the current dissection manuals is they include much of the same informationas gross anatomy textbooks. As a result of this thoroughness, current dissection manualsare difficult to use as dissection guides because the anatomic text is dispersed among thedissection instructions. Thus, the anatomic text interrupts the dissection instructions.From students' perspective, too much searching is required to locate the dissectioninstructions. Another linlitation is that lists of anatomic structures are not provided in thecurrent dissection manuals, which would efficiently guide students regarding what theyare expected to learn.

Some of the most frequently used dissection manuals commercially availableinclude Grant's Dissector (Sauerland and Sauerland, 1999), The Stanford Project (Chase,Dolph, Glasgow, Gosling, Mathers, 1996), Dissector for Netter's Atlas ofHumanAnatomy (Oberg, 1994), Clemente's Anatomy Di..\'sector (Clemente, 2002) and Anatomy.A Dissection Manual andAtlas (Jacob, 1996).

Grant's Dissector is one of the most commonly used dissection manuals in healthprofession schools across the nation. Grant's Dissector contains a great deal ofanatomical text mixed with instructions for dissection. Yellow highlighting is used todraw attention to the dissection instructions. Despite this highlighting approach,dispersion of the dissection instructions in the voluminous text makes pinpointing the


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dissection instructions difficult. Grant's Dissector has good illustrations to guidestudents, but many of the illustrations are extraneous to the task of dissection.Furthermore, most of the illustrations are not positioned on the page with the relevantdissection instructions. Consequently, students use valuable dissection time flippingpages back and forth looking for illustrations and sifting through long sections of text insearch of dissection instructions.

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The Stanford Project is a dissection manual formatted in a three-ring binder andreferenced to a corresponding atlas called the Clinical Anatomy Atlas (Chase, Dolph,Glasgow, Gosling, Mathers, 1996). The pages are laminated, which permits them to beeasily cleaned when soiled with preserving fluid and debris. Very simple colorillustrations are provided on each page, with instructions directing students to the atlas forfurther illustrations. Herein lies a problem: students use a good deal of their timesearching the atlas to find illustrations related to their dissection, in part because of thepaucity of illustrations in the dissection manual. Another problem is the dissectioninstructions are brief and therefore do not provide complete guidance.

The Dissectorfor Netter's Atlas ofHuman Anatomy is not practical as well. Itcontains illustrations similar to the Atlas ofHuman Anatomy (Netter, 1997); however, theillustrations in the dissection guide are small and unclear and often do not provide anappropriate example of structures described on the page. The dissection instructions alsofurnish insufficient direction to dissect and identify structures.

Clemente's Anatomy Dissector (Clemente, 2002) and Anatomy. A DissectionManual andAtlas (Jacob, 1996) are both formatted similarly to the above listed manuals.


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Therefore, neither Clemente's nor Jacob's guide address the problem faced by medicalstudents to efficiently perform dissections.

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Grant's Dissector was used at the University of Utah School ofMedicine prior tothe fall of 2000 and the students were unable to finish the assigned dissections by the endof each laboratory period. Consequent!y, they had to return to the gross anatomylaboratory after hours to finish their dissections. This situation was a problem years ago,when the gross anatomy course was spread over seven months. Since the 1997-98academic year, the gross anatomy course has been taught in four months. Therefore, theproblem of not being able to complete the assigned dissections has become even morepressing. Furthermore, complaints increased from the students regarding the lack of listsof anatomic structures that they are expected to dissect and therefore learn.

The solution to this dilemma described here was to create a practical dissectionguide for human anatomy that contains the following attributes: Written instructions - the written instructions should be clear and complete for

students to understand, to dissect, and to identify anatomical structures. Studentsshould also know what they were expected during each dissection session.

Illustrations - enough illustrations should be included to visually direct the student'sdissection and to identify all of the anatomical structures. The illustrations shouldalso be clear and simple.

Format - the layout of the dissection guide should allow the text and illustrations to beside by side to avoid unnecessary page turning.


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Efficiency - the dissection guide should allow students to be efficient and to finishevery dissection within the laboratory period.

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Initially I began by writing the first halfof the Dissection Guide for HumanAnatomy as my master's degree thesis. The principles whereby the guide was writtenincorporated the four aforementioned attributes. I organized the manual for students toefficiently complete a dissection during the time allotted. Text was edited to be conciseand focused while still providing clear instructions and identifications. Furthermore,each page contained text and at least one corresponding picture illustrating dissectiontechnique and/or structures to identify. The initial dissection guide was used at theUniversity of Utah School ofMedicine for their cadaver dissections during the fall of1999. The guide was such a success that I continued the project as my doctorate

dissertation. My goal was to finish the dissection guide. Since the completion ofmymaster's degree in the spring of 2000 I completed the manual and signed a contract withElsevier Science during the spring of 2002 to publish the dissection guide internationally.The guide was then sent to various anatomy authors around the country for their critique.

The full version of the dissection guide was used at the University of Utah SchoolofMedicine during the past three academic years (fall 2000-2002). The dissections werecompleted in the allocated time and the students required less guidance from instructorscompared to previous years.

We conclude that the Dissection Guide for Human Anatomy is a practical manualfor teaching human gross anatomy to medicat dental and graduate students. We


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speculate that this manual will be useful for teaching gross anatomy to health professionstudents in other disciplines.

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METHODS

The philosophy behind writing Dissection Guide for Human Anatomy was toproduce a guide for efficient dissection of the human body. The philosophy was not toproduce a textbook or an atlas of the human body. My goal was to make the guidepractical and easy to follow for medical and dental students so that they will finish eachdissection during an assigned laboratory period. Another goal was to provide thestudents with clear expectations of the material to be dissected and learned. This requiredthat I select a format to subserve each goal. I wrote each of the chapters for thedissection guide and illustrated the pictures. With the help ofmy co-authors, Kurt H.Albertine and Kerry D. Peterson, the text and images were then edited numerous times toensure optimal dissection instructions.

Selecting the best possible format for the Dissection Guide for Human Anatomyproved challenging. One of the challenges was to juxtapose text and the relatedillustration(s) on the same page. This challenge was met by orienting the pageshorizontally (often referred to as landscape format). By selecting a horizontal page

format, I was able to position the text on the same page as the correspondingillustration(s). Thus, each page is divided in halfby a vertical bar, with text positionedon the left and the corresponding illustration(s) on the right.

A related challenge was stability of the guide on the bookracks that are attached tothe dissection tables in the gross anatomy laboratory. The bookracks are wider than theyare tall, and they are slanted slightly backward. Therefore, tall books tend to fall off the


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bookracks. This problem was inadvertently reduced by the horizontal page format and byspiral binding the guide on the short side of the pages. When the guide is opened, twopages are displayed horizontally. Thus, the guide is wider than it is tall and therefore isstable on the bookracks. An added benefit of this formatting design is the information ontwo pages is displayed.

Font format was assigned as 12-point to make the font large enough to read butnot so large that little text fit onto a page. Each page was formatted as a two-columntable. The table format simplified setting the margins. Another benefit of the tableformat is it held the inserted pictures at the location where they were inserted. Had I usedMicrosoft Word (Microsoft Corporation, Redmond, WA) in its nonnal page format, theenormous number of pictures would have been inserted as object files. However,

Microsoft Word is not designed to handle large numbers of inserted objects. OnceWord's threshold is reached, the next object files that are inserted cause all of the insertedobject files to move randomly throughout the document. The only way that I couldprevent this disastrous consequence was to format the pages as two-column tables.

I assigned bold font style to the names of anatomic structures the first time that astructure was identified in the text. I used this design for two reasons: 1) to signal tostudents that the named structure is to be dissected and identified and 2) to highlight a"hotlink" to image files in the Web-based translation of the dissection guide that is beingcomposed as a companion to the dissection guide. The Web-based version containsphotographs of prosections, bones, models and radiographs. By using "hotlinks" to


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connect the text to the image folders, I created a rapid means for students to efficientlyview high-resolution images of anatomic structures.

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The illustrations in the guide are simple line drawings displayed in black-and-white. I created each of the drawings, so they do not infringe copyright laws. I chose theblack-and-white style because it focuses the students' attention on a specific dissectiontask. A rainbow of colors does not distract their attention. Also, black-and-whiteillustrations are inexpensive to print.

Each illustration was hand-drawn with pencil. Guidance for the illustrations camefrom viewing the following gross anatomy textbooks and atlases: Anatomy A RegionalAtlas of he Human Body (Clemente, 1981), Atlas ofHuman Anatomy (Netter, 1997},Clinically Oriented Anatomy (Moore and Dalley, 1999), Color Atlas ofHuman Anatomy(McMinn and Hutchings, 1988), Grant's Atlas ofAnatomy (Agur and Lee, 1999) andGrant's Dissector (Sauerland and Sauerland, 1999). Tips for perspective and proportionwere gleaned from Anatomy for the Artist (Barcsay, 2000) and Artistic Anatomy (Richerand Hale, 1986). The illustrations were edited by Kerry Peterson and Dr. Albertine, whoemphasized simplicity, clarity and necessary labeling only. I did not want to complicatethe illustrations with numerous labels. Black ink was traced over the revised pencil lines.The revised pen-and-ink illustrations were scanned into Adobe Photoshop (AdobeSystems Incorporated, San Jose, CA), using a flatbed scanner (Epson AmericaIncorporated, Long Beach, CA) connected to a PC-compatible computer.

I used Adobe Photoshop to add text, lines and shading and to crop theillustrations. The illustrations were saved as three versions. The first version was the


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original scanned illustration, saved in Tiff (.tit) format. The second version of theillustration as an Adobe Photoshop document (.psd) after the text, lines and shading wereadded. The Photoshop file format preserves the text, lines and shading as independentlayers. The third version was the final product, in which all of the Photoshop layers wereflattened into a single layer. The third version was also saved in Tiff format.

The utility of saving each illustration as three versions was discovered during therevision process, when text labels were modified, lines were altered and/or shading wasadjusted. Flexibility to change one or more layers, without altering other layers, isprovided by files that are saved as Photoshop documents.

Once the illustrations were revised, saved as Photoshop documents and flattenedas tiff files, the illustrations were inserted into a text box in Microsoft Word within the

table format. The text box option allowed us to position each illustration appropriatelyon the right halfof the horizontally formatted page. The text box option also allowed meto adjust the size of the inserted illustration to the available space on the page.

Dissection Guide for Human Anatomy is organized according to the schedule forthe human gross anatomy course taught at the University of Utah School ofMedicine.This course is divided into the following four units.

Unit 1: Back and ThoraxUnit 2: Abdomen, Pelvis and PerineumUnit 3: Neck and HeadUnit 4: Limbs


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Each unit is subdivided into individual laboratory periods. The number of laboratoryperiods in each unit varies.

This doctorate dissertation presents the entire Dissection Guide for HumanAnatomy. The Units of the dissection guide are divided into the following laboratoryperiods:

Unit 1 - Back and Thorax1. Superficial Back2. Deep Back and Vertebral Column3. Spinal Cord4. Anterior Chest Wall and Breast5. Thoracic Situs and Lungs6. Heart7. Mediastina

Unit 2 - Abdomen, Pelvis and Perineum8. Anterior Abdominal Wall9. Peritoneum and Foregut10. Midgut and Hindgut11. Posterior Abdominal Wall12. Gluteal Region and Ischioanal Fossa13. Urogenital Triangle14. Pelvis and Reproductive Systems

Unit 3 - Neck and Head

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15. Posterior Triangle of the Neck16. Anterior Triangle of the Neck17. Visceral Triangle, Brain and Base of Skull18. Base of Skull and Cranial Nerves19. Orbit20. Superficial Face21. Deep Face and Pharynx22. Nasal Cavity, Palate and Oral Cavity23. Larynx and Middle Ear

Unit 4 - Limbs24. Upper Limb: Osteology and Superficial Structures

25. Upper Limb: Musculature26. Upper Limb: Nerves27. Upper Limb: Vasculature28. Upper Limb: Hand29. Upper Limb: Joints30. Lower Limb: Osteology and Superficial Structures31. Lower Limb: Musculature32. Lower Lirnb: Nerves33. Lower Limb: Vasculature34. Lower Limb: Foot35. Lower Lirnb: Joints


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The guide for each laboratory dissection period begins with a table that identifiesthe structures to be dissected. The pages that follow contain the text and illustrationsdirecting the students' dissection. At the end of each unit, a comprehensive tableidentifies all of the structures that were dissected and therefore to be learned. Thesetables do not identify every anatomic structure that is present in a region, for example aspresented in the British or American editions ofGray's Anatomy (Gray, 1977, 1973). Idid not make the tables all-inclusive because the current anatomy course is only 137hours. The course does not have sufficient time to include every anatomic structure.Therefore, the tables in Dissection Guide for Human Anatomy represent my editorialdecision for inclusion. My decision for inclusion is based on practical experience duringthe past four years, when I learned the limits of inclusion by trial and error, as well as bystudent feedback. I recognize that my dissection guide is a distillate and not the totalbody of gross anatomic information.

I revised the guide four times before it was used for our human gross anatomycourse in the fall of2000, when the guide was student-tested by 104 medical students and10 dental students. Since then, the department ofNeurobiology and Anatomy has usedthe dissection guide during the fall of 2001 and 2002, with over a 100 medical and 10dental students per academic year. Throughout the course each year, student input wassolicited for identification of errors and suggestions for improvement. At the end of eachyear's course, a questionnaire was given to every student to obtain anonymous critique ofthe dissection guide. These forms of critical evaluation prompted additional revision.


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In May of2002, the authors of the Dissection Guide for Human Anatomy(Morton, Peterson, Albertine) signed a contract with Elsevier Science (Elsevier Science,St. Louis, MO) for publication. Numerous human gross anatomists from other medicalschools in the United States and United Kingdom reviewed the dissection guide andsubmitted suggestions for improvement. Using three years of student feedback, andsuggestions from other anatomists, I composed the final version of the dissection guidefor publication.

To help determine the dissection guides effectiveness, a questionnaire wasdistributed to the medical and dental students after they completed the anatomy course inthe fall of 2002. The questionnaire was distributed two months following the completionof the anatomy course. All students received the questionnaire; 41 completed thequestionnaire. Based on the dissection guide's format and philosophy, the questionnaireconsisted ofquestions to be answered on a five-point Likert scale ("strongly agree" = A,to "strongly disagree" E). The questionnaire addressed the text, illustrations, format,and efficiency of dissection (copy of the questionnaire is attached) and was e-mailed inFebruary 2003, followed by a reminder one week later.

Responses were collected from 41 first-year nledical students (41 010 responserate). The respondents included 30 (73%) men and 11 (270/0) women, with the mean ageof 26 years. Most of the participants were predominantly from white descent (95%), witha small percent being from Hispanic descent (5%). Those who participated in thequestionnaire came from a variety of educational backgrounds (See Table 1.)


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Only 31% of the questionnaire participants had no academic experience in ahuman gross anatomy course prior to medical school (see Table 2.).

Table 1. - Degrees earned by medical studentsDegree categories* Nurnber of J,articipantsBiological sciences 23Phy_sical sciences 6Liberal arts 6Other 7Master's degrees 5* Associates degrees and minors were not included in this chart* SOlne students had double majors and more than one degree

Table 2. - Academic experience in human gross anatomy

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Academic experience N urnher of participantsCombined anatomy and physiology course 23Plastic model-based 5Human cadaver-based, without perfonning 22dissectionsHuman cadaver-based, with performing dissections 5Teaching assistant for a human gross anatomy 5course I


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RESULTS

The Dissection Guide for Human Anatomy consists of over 420 pages of text andmore than 450 original black-and-white illustrations (see Appendix). The pages areoriented horizontally. The left side of the page contains the text and the right sidecontains the corresponding illustration( s). The left margin was bound with a spiralallowing the guide to be opened to two pages simultaneously and giving the bookstructural stability on the bookracks are attached to my dissection tables. Theillustrations are simple line drawings that are displayed in black-and-white. The black-and-white style focuses the students' attention on the dissection task. Labels are kept to aminimum for the same reason.

Each illustration is saved as three versions. The first version is the originalscanned illustration in Tiff format. The second version contains the added text, lines andshading and is saved as an Adobe Photoshop document. The third version is the finalproduct, in which all of the Photoshop layers are flattened into a single layer. The thirdversion is also saved in Tiff format and inserted in the completed guide.

The dissection guide contains dissection instructions for 35 laboratory periods.Each laboratory period's instructions begin with a structure list. Each unit ends with acomprehensive list of structures that were to be dissected.


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Prior to the 1997-98 academic year, students lost time guessing the direction eachdissection was to take and knowing what was required of them to learn during eachlaboratory session. During the past three academic years, when students used the

Guide for Human Anatomy, both problems were minimized. Also, thedissections were accomplished more efficiently and with less guidance from thelaboratory instructors. As a result, students finished each dissection by the end of thelaboratory period. Because the dissections were perfonned more efficiently and requiredless guidance by instructors, more teaching and discussion of anatomy was possible.

The results from the questionnaire are as follows: Text

93% (38 of41) of the participants responded that they agreed that both listsaccurately covered the structures that would be dissected during the laboratoryperiod.

76% (31 of 41) of the participants felt that the dissection instructions were clearand 90% (37 of41) felt the dissection instructions followed an orderly and logicalsequence.

Illustrations 62%) (25 of 41 ) of the participants disagreed that anatomical atlases and other

reference books were necessary in order to accomplish the dissections. 81 % (33 of 41) of the participants felt that illustrations were easy to interpret and

71% (29 of41) felt that the figure labels were consistent with the accompanyingtext.


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74% (30 of 41) felt that the figures contained sufficient information to reveal andidentify the desired structures.

Format 95% (39 of41) of the participants agreed that the landscape fonnat, with text on

the left and figures on the right, enabled easy reference while dissecting. 880/0 (36 of41) of the participants liked the bulleted format of the text because it

made following the dissection instructions easy. Efficiency

790/0 (32 of 41) of the participants were either neutral or disagreed with thepremise that the dissections were difficult to accomplish in the scheduled time.


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DISCUSSION

The Dissection Guide for Human Anatomy is completed, the four units of whichare submitted as part of the requirements for a doctorate in anatomy. The book was usedto guide dissection for first-year medical and dental students at the University of Utah'sSchool ofMedicine during the falls of 2000, 2001 and 2002. The students successfullycompleted dissections by the end of each laboratory period and required less guidancefrom the laboratory instructors. Thus, more time was available for laboratory instructorsto teach human gross anatomy and discuss clinical correlation than in previous years. Themanual helped the laboratory instructors prepare for each session and fewer anatomyatlases were used by students in the laboratory.

Human gross anatomy is one of the required core classes taken by first-yearmedical students because it is the foundation on which many other medical courses anddisciplines build. Student mastery of gross anatomy is important for this reason. Forexample, during their second year in medical school, students cover body systems from aclinical approach. Unless medical students possess a "big pictureft understanding of these

body systems' anatomical makeup, they will lack a complete understanding necessary forfuture practice. As a result, failure to master gross anatomy may adversely affect medicalstudents' future practices as physicians.

In 1939, medical schools devoted 338 hours to gross anatomy lecture andlaboratory (Eldred and Eldred, 1961). This amount of time allowed the enormousvolume of anatomical material to be taught, at some institutions over a two-year period


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(Eldred and Eldred, 1961). The medical students used books such as Gray's Anatomy(Gray, 1977) to learn detailed anatomic descriptions and to dissect the human body. Astime progressed and scientific advancements in biomedical sciences expanded, curriculawere modified to accommodate the new information. The modifications necessitatedreduction in curriculum tinle for core basic science courses. Consequently, human grossanatomy curriculum hours were progressively reduced. For example, in 1955, thenumber of hours dropped slightly to 330 hours in the United States and Canada (Eldredand Eldred, 1961). By 1966, the time allocation was down to 290 hours. Reduction hasnot stopped since then. Human gross anatomy courses dwindled to 197 hours in 1973(Blevins and Cahill, 1973), 182 hours in 1991 (Collins et aL, 1994) and 165 hours in1997.

The University ofUtah School ofMedicine is currently at par with most medicalschools in the year 2000. The human gross anatomy course is but 137 hours. This timeframe incorporates lectures, laboratories and examinations. The course is partitioned into31 sessions, each composed of a one-hour lecture followed by two to three hours oflaboratory dissection. Thus, only a fraction of the time is available today to teach humangross anatomy compared to six decades ago.

Although gross anatomy curriculum hours are reduced, students are still requiredto dissect an entire cadaver. However, the current dissection manuals are written asthough medical students have ample time to dissect and learn. Current dissectionmanuals, such as Grant's Dissector (Sauerland & Sauerland, 1999), contain largevolumes of text describing the gross and clinical anatomy. The text is written in the style


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of a textbook. Medical students today do not have the time to sift out the dissectioninstructions from the text.

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Grant's Dissector (Sauerland & Sauerland, 1999) responded to the currentsituation by highlighting the dissection instructions in yellow to separate the dissectioninstructions from other text. The problem still remains, however, of having too much textthat distracts and confuses the students during dissection. Dissection Guide for HumanAnatomy addresses the time constraint challenge by excluding extraneous text and thuspromoting efficiency. Moreover, by avoiding duplication ofmaterial from textbooks, myguide provides clear, straightforward instructions for dissection of the hwnan body.

Grant's Di..\'sector (Sauerland & Sauerland, 1999) also contains numerousillustrations, many ofwhich appear to have limited utility during dissection. Also, manyof the illustrations are separated from the corresponding text. A common complaint bystudents is they lose time flipping pages back and forth, trying to correlate theinstructions to the illustrations. Dissection Guide for Human Anatomy solves thisproblem by having the text and corresponding illustration(s) on the same page.

The difficulty with the Dissectorfor Netter's Atlas ofHuman Anatomy (Oberg,1994) is that it provides minimal dissection instruction and anaton1ic structuredescription.

The Standford Project (Chase, Dolph, Glasgow, Gosling, Mathers, 1996) containsuseful dissection however, more are needed from the student perspective.The Standford Project manual directs students to another atlas to study images ofdissected regions. Students struggle to interleaf the two books while they dissect. Again,


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Dissection GUidefor Human Anatomy solves this problem by placing the appropriateillustration(s) beside the corresponding text.

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In Dissection Guide for Human Anatomy, each laboratory dissection instructionbegins with a table that identifies the structures to be dissected. The pages that followcontain the text and illustrations directing the students' dissection. At the end of eachunit, a comprehensive table identifies all of the structures that were dissected andtherefore are to be learned. However, these tables do not identifY every anatomicstructure that is present in a region. I did not make the tables all-inclusive, as presented inthe British or American editions of Gray's Anatomy (Gray, 1977, 1973), because thecourse today is only 137 hours, and the students lack sufficient time to identifY everyanatomic structure. Therefore, the tables in Dissection Guide for Human Anatomyrepresent my editorial decisions for inclusion. I recognize this limitation for each list. Iendeavored to include the main anatomical structures from each region of the body to aidthe students, learning effort. Consequently, when a student studies a body region in moredetail (i.e., during the surgical rotation in the third and fourth year of medical school),he/she will have the anatomical background necessary to be successful.

The dissection guide will be translated to a Web-based multimedia teaching tool.I created the template for this teaching tool during the summer of 2000 and tested itduring the gross anatomy course last fall. I envision that the students will use the web-based version to study the laboratory material from their home or library.

A limitation ofDissection Guide for Human Anatomy is absence of clinicalcorrelations. My guide suffers from this omission because student enthusiasm increases


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when they see clinical relevance. Our challenge will be to integrate clinical correlationsto the Web-based translation.

Another limitation to this study is the lack of an educational outcome'scomparison between the Dissection Guide for Human Anatomy and commerciallyavailable dissections guide (i.e., Grant's Dissector). Without such a comparison, I cannot correlate the dissection guide's effectiveness with an already available commercialdissection guide. Such a comparison will be performed this summer (2003) and next(2004). For this reason I have sought and obtained funding to conduct a prospective,educational outcome research project over the next two summers. I will have a group of40 students who have been accepted as first-year medical students at the University ofUtah School of Medicine (class of2007). Another group of 40 students will be enrolledfrom the class of 2008. Each group of 40 students will be divided equally into twogroups. One group will use the Dissection Guide for Human Anatomy, and the othergroup will use Grant's Dissector. Another 40 students will be recruited from thesubsequent class of medical students. I will compare efficiency of dissection and indicesof comprehension between the two groups. The students will fill out a daily log toaddress issues about each dissection and to determine the number of structures identifiedduring each dissection period.


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APPENDIX

DISSECTION GUIDE FOR HUMAN ANATOMY


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Dissection Guide for Human Anatomy;

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Transcript of Dissection Guide for Human Anatomy;