Gross Anatomy is the signature course of medicine in the basic sciences. It provides a foundation for understanding body structure and, for many students, an introduction to the language of medicine. Our course in Gross Anatomy and Embryology is based upon study of regions of the body.  The schedule is largely determined by the length of time necessary to comprehend the anatomy and clinical importance of a particular region.

LABORATORY PROSECTIONS

            The Gross Anatomy laboratory focuses upon the study of prosections.  Prosections are dissections of donated human bodies that are done in advance and stored for future study.  Body donations are selfless acts made with the aim of helping your development as a physician. The prosected specimens represent donations that have fulfilled the goal of aiding in teaching human anatomical structure to many future physicians. Most of the prosections studied in the Gross Anatomy laboratory are dissections that were performed by students during the summer after completion of their first year of medical school.   These prosections, therefore, are the result of careful and painstaking work of medical students for study by other students.

            This is probably the only opportunity you will have to explore the structure of the human body in such detail. Cadaver prosections are your best resource for learning about the structure of the human body as it relates to medicine. In many cases, you will see differences in anatomical structure due to individual variations.  You will also observe evidence of disease processes and surgeries that were performed.  Use this opportunity wisely to develop important professional attitudes. ALWAYS and IN ALL WAYS treat the prosected specimens with respect.  You should recognize that they represent donations of human beings who have given their bodies to benefit your efforts to help other humans. 

            To aid in studying Anatomy, digital photographs were taken of each of the prosections and relevant structures were labeled.  Copies of these digital images are distributed to students and are available in the laboratory as laminated photographs placed next to the prosected specimens.  Students can study the digital images and the prosections at any time, as the laboratory is open at all times during the course. Faculty are available to answer questions on the prosections during every laboratory session. Students are tested on the prosections in practical examinations.  Most questions will test knowledge of structures that were labeled in the digital images. However, practical exam questions may require more than the identification of structures. Students may also be asked to provide information from lecture material (ex. muscle actions or innervation).  Practical exams may also require identification of structures on specimens that have not previously been studied in the laboratory.

            Sets of radiographic images (x-ray films, CTs, MRIs) will be given out on disc for study in each region of the body.  Some of these images are derived from CT scans of the same cadavers that have been prepared as prosections.  Anatomical structures have been labeled on all images and they will be included in the practical examinations.

            Students will also be given sets of human bones (bone boxes) and skulls for study in groups.   Lists of structures to be identified on bones and skulls will be distributed and this material will also be included in practical examinations.   

LECTURE MATERIAL

            We strive to provide an environment, particularly in the laboratory, in which you can actively learn the gross anatomy needed for your education in the practice of medicine. To assist you in your learning, the faculty have developed notes and lecture outlines as handouts. You should read and study these handouts! If there is a lecture on the handout subject matter, be sure to read the handout prior to the lecture covering that material. Following a lecture you should study the handout again as soon as possible that same day. Not all the material for which you are responsible will be covered in lectures.

            All three texts recommended for the course, Clinical Anatomy, 8^th edition, by R. S. Snell, Clinically Oriented Anatomy, 5^th edition, by K. L. Moore and A. F. Dalley, and Gray's Anatomy for Students, 1^st edition, by R. L. Drake, W. Vogl & A. W. M. Mitchell, are readable and clinically oriented. Use a text to clarify points, to improve your understanding, and to gain additional insights into the importance of human anatomy in the practice of medicine. Also, in some of the handouts, references are given to specific figures in a text or atlas. When studying the handouts you should refer to those figures, as well as to other appropriate figures in the texts and atlases.

            Embryology is incorporated into the course to assist you in understanding normal human development, formation of organs and abnormal development. The structures and anatomical organization of many regions of the body are a direct consequence of the processes of development, some of which can be quite complex.  It is strongly recommended that you read the notes for those lectures prior to class and consult the recommended embryology text, Langman's Medical Embryology, 10^th edition (T. W. Sadler, editor), for clarification and illustrative examples.   

COURSE OBJECTIVES

The objectives of the course are:

1.         To facilitate the attainment of a level of knowledge and understanding of human gross anatomy and embryology sufficient to comprehend the morphological basis of medical practice.

2.         To introduce a variety of non‑invasive imaging techniques, such as X-rays, CT and MRI        scans, and arteriograms, and the interpretation of anatomy as visualized by such techniques.

3.         To provide exposure to the range of variability included in normal human anatomy.

4.         To nurture professional attitudes towards patients, colleagues and others.

5.         To reinforce professional ethics and behavior.

6.         To foster the development of a level of self‑discipline and self‑confidence sufficient to permit independent learning.

7.         To aid in the attainment of adequate study skills.

8.         To enhance critical reading and comprehension of the anatomical portion of the medical literature and to promote an understanding of evidence-based medicine and life-long learning.

These course objectives and the course itself contribute to meeting several of the Learning Objectives in Knowledge, Skills, and Attitudes and Behavior of the Joan C. Edwards School of Medicine (http://musom.marshall.edu/documents/JCESOM_learning_objectives.pdf)

Expected Outcomes for Students

Students are expected:

            To demonstrate a working knowledge and comprehension of human anatomy and embryology. This will include the ability to recognize, recall, integrate, and apply to the clinical setting anatomical information on formative and summative evaluations.

            To demonstrate appropriate professional attitudes and respect towards other health care professionals, including peers, faculty and mentors, and other persons. This will include the ability to communicate with health care professionals and others in an appropriate manner. Such behavior will include working conscientiously and cooperatively with them and being truthful.

            To participate actively and cooperatively in teamwork. This will include active participation in small groups, e.g., during peer-teaching, peer-learning, and with faculty. 

GROSS ANATOMY TEXTS, ATLASES AND SOFTWARE

Recommended gross anatomy texts (choose one of the three):

1. Snell, R. S., Clinical Anatomy by Regions, 8th ed., ISBN 0-7817-6404-1, Lippincott, Williams and Wilkins
OR
2. Moore, K. L., and A. F. Dalley, Clinically Oriented Anatomy, 5th ed., ISBN 0-7817-3639-0, Lippincott, Williams and Wilkins
OR
3. Drake, R. L., W. Vogl, and A. W. M. Mitchell, Gray's Anatomy for Students, 1st ed., ISBN 0-443-06612-4, Elsevier

Recommended embryology text:
1. Sadler, T.W., Langman's Medical Embryology, 10th ed., ISBN 0-7817-9485-4. Lippincott, Williams and Wilkins

Recommended Atlases: (choose one of the following):

1. Agur, A. M. R. and A.F. Dalley, Grant's Atlas of Anatomy, 12th ed., ISBN 07817-7055-6. Lippincott, Williams and Wilkins
OR
2. Netter, F.H., Atlas of Human Anatomy, 4th ed., 1-4160-3385-8, Elsevier
OR
3. Rohen, J. W., C. Yokochi, and E. Lutjen-Drecoll, Color Atlas of Anatomy: A Photographic Study of the Human Body, 6th ed., ISBN 0-7817-9013-1, Lippincott, Williams and Wilkins
OR
4.  Moses, K.P., J.C. Banks, Pedro B. Nava, and D. Petersen, Atlas of Clinical Gross Anatomy, 1st ed., ISBN 0-3230-3744-5, Elsevier
OR

5. Gilroy, A.M., B.R. MacPherson, L.M., Ross.  Atlas of Anatomy ISBN 978-1-60406-062-1, Thieme Medical Publishers.

OR

6. Drake, R.L., Vogl, A.W., Mitchell, A.W.M., Tibbits, R.M., Richardson, P.E. Gray’s Atlas of Anatomy, ISBN: 978-0-443-06721-1, Elsevier

Dictionary (highly recommended)

Stedman's Electronic Medical Dictionary Version 7.0 CD-ROM for Windows. CD version has audio files that pronounce words.
 

Software available either on DITMI computers or the computers in the Gross lab 

1. ADAM Interactive Anatomy Student Lab Guide w/Windows DVD Package (3rd Edition) by Mark Lafferty, Sam Panella, ISBN 0805372326, available in the bookstore.

2. Cross-Sectional Anatomy Tutor - A Gallery of Images, CD-ROM, ISBN 0763706922, Duke University.  

DVD

Several titles are available and are referenced in the appropriate handouts. One you might particularly consider for its step-wise approach is Acland's Video Atlas of Anatomy. There are 6 videos in Acland's covering various regions of the body. These videos are available in DVD format or as VCT tapes.

Web sites

            A web site devoted to the course is at http://musom.marshall.edu/courses/acb720/.  There is also a page of references to websites that may be particularly useful for students at http://musom.marshall.edu/courses/acb720/links.asp.  These pages can be accessed by using your personal password.  Other websites are maintained by Faculty members for distribution of course materials.  

Required Equipment and Supplies

Laboratory Coats for dissecting

            Each student should wear a lab coat in the Gross Anatomy laboratory.  We make lab coats available during the Introduction to Gross Anatomy session. If our supply of lab coats is exhausted, students must provide one. Students who want their own lab coat may purchase one in the bookstore or elsewhere. Wear your name tag on your laboratory coat so your faculty and classmates know who you are.

Gloves for handling prosections

            Gloves are needed for the gross anatomy laboratory. Gloves protect your hands from skin irritation and absorption of hazardous materials, e.g. formaldehyde. All students must wear proper gloves while handling prosections.  Boxes of disposable gloves will be available in the Gross Anatomy laboratory.  Other more permanent gloves can be brought in by students at their own cost.

Ancillary Texts, Equipment and Resources

            The medical bookstore area at the MU Memorial Student Center has a number of anatomy texts and atlases other than those recommended for this course. Some of these may be helpful, but are not necessary. As your knowledge and appreciation of anatomy increase, you may want to consider purchasing additional learning resources, including appropriate software and reference books.

Pregnancy

            If you are pregnant or become pregnant during the course, you must take additional steps to protect the well-being of your developing child. You MUST inform your obstetrician of your situation with respect to the gross anatomy laboratory. If your obstetrician approves your choice to participate in the laboratory, then that approval must be provided in writing to Dr. Zill. Additional steps to be taken for your participation in the laboratory include wearing an organic vapor mask (respirator) to further reduce exposure to formaldehyde and other hazardous vapors. You should work for no longer than an hour in the dissecting lab without taking a 10-15 minute break outside the lab. You should always use vinyl or nitrile gloves AND double glove. We desire to provide you and your developing child with a high margin of safety!

ATTIRE AND DEMEANOR

            During ALL class activities, students are expected to dress and conduct themselves in a professional manner. This includes treating prosected cadavers with respect at ALL times, wearing a lab coat, gloves and a name tag in the laboratory.

            Prosections and/or cadavers MUST NOT BE DISCUSSED IN PUBLIC PLACES.

            Eating, drinking and use of tobacco are prohibited in the laboratory and food, beverages and tobacco products should not be brought into the laboratory.

GENERAL COMMENTS

Course

            The laboratory sequence closely follows the lecture sequence. Lectures are designed to:

            1) explain selected anatomic concepts and details illustrated in a particular region,

            2) aid students in the identification of structures to be visualized in the lab,

            3) emphasize relationships and structures of clinical importance, and

           4) explain how certain structures and/or relationships develop embryologically.

            Several times throughout the semester, clinicians give presentations concerning some aspect of the region under consideration. These lectures contribute to the above listed functions and emphasize the value of anatomy to the practice of medicine. Material from these clinical lectures may be included on examinations.

Laboratory

            1. Prosected cadaver specimens must be treated with respect at all times! You are the beneficiary of a gift to assist you in your development as a physician. The Gross Anatomy Laboratory is a restricted area and the Rules and Regulations of the West Virginia Anatomical Board STRICTLY apply to this laboratory. Read these Rules and Regulations carefully (Gross Anatomy home page and posted in the laboratory). You are expected to attend each laboratory period.

            2. NO CADAVER MATERIAL IS TO BE REMOVED FROM THE LABORATORY! Photography (digital or conventional) is prohibited!

            3. Any potential visitors to the gross anatomy laboratory MUST be cleared in advance and in writing by Dr. Zill. Only persons with some health care background and a legitimate reason for being in the laboratory will be considered for granting access. Requests for permission for entry to the laboratory must be made in writing to Dr. Zill. If an unauthorized person enters the laboratory, ask them to leave and notify one of the instructors.

            4. Laboratory coats with long-sleeves, name tags and gloves are to be worn at all times. It is recommended that you wear eye glasses or other protective eyewear, e.g., safety goggles. Wearers of contact lenses, especially soft lenses, may experience some additional eye discomfort; therefore, students who wear contacts may want to wear their eye glasses in the lab. Open-toed shoes or sandals are not allowed because of the possibility of exposure to fixatives.

            5. Only blunt probes or forceps are to be used on prosections. However, if you are accidentally cut or scraped, a first aid kit can be found in the upper right drawer on the white-board side of the center island table. A more serious injury may require you to go to the VA Hospital Emergency Room and complete an accident report.          

            6. Drying out is the biggest threat to the condition of prosections. Keep prosections moist with the preserving fluid in the squeeze bottles, NOT with tap water. When finished studying prosections, be sure to moisten the material and cover it properly with moist towels. Dried out prosection material is virtually useless. Refill the bottles as needed with the fluid in carboys above the sinks.

            7. The prosections are available at all times.  If you are studying the prosections before or after class hours, please be sure that they are all covered and moist.  Also, check on the prosections that others might have studied.   Preserving the prosected material both aids your studies and serves as a recognition of the contribution that donors have made to your education.        

            8. Treat all skeletal materials and laboratory models with great care. Most are fragile and all are expensive.

            9. Maintain the area around the prosections. Immediately clean up spills with paper towels. The floor becomes extremely slippery with fluid or tissue debris! BE CAREFUL! At the end of a laboratory session, ensure that the area around your table and the prosections is clean.

            10. Spend part of your time in lab studying the examples of non‑invasive imaging techniques, such as radiographs, CT and MRI scans, angiography, etc. These images comprise part of the laboratory examinations.

            11. Remember that this course provides most of you with the only opportunity you will have to actually see and study most of the structures and relationships that will be important to you in the practice of medicine. Hence, it is important for you to devote as much time to the laboratory as possible. Hopefully, you will be able to acquire an ability to "see in your mind's eye" the anatomy of a region when all you will actually see is the surface of the patient.

            12. Enter and leave via the south lab door (214B), and make sure doors are kept closed and locked except when entering or leaving the laboratory.

LABORATORY EXPERIENCE

hic locus ubi mores gaudet succurrere vitae (here is the place where death enjoys helping life)

            The laboratory is the place to learn Human Gross Anatomy. If you make full use of the laboratory experience, the amount of time required for outside of class study will be reduced.

            On Wednesday afternoon (August 6), you will be introduced to the Gross Anatomy Laboratory, receive a key to the laboratory, and complete required forms. You will need to bring a total of $15 (cash or check) to this Introduction to Gross Anatomy laboratory session. This $15 is payment of a $5 laboratory key replacement fee (refundable at end of the first year with return of your key), a $5 usage fee for a skull (non-refundable), and $5 for the gloves and atlas. The skull must be returned in good condition before your grade for the course will be submitted to the Registrar.

            As you become acquainted with your fellow students, decide who you are going to work with as partners. Each group of four students must complete a "Group Assignments" form posted on the bulletin board outside the Gross Anatomy laboratory, 214B Medical Education Building (MEB), and return the completed form to the bulletin board as soon as possible and no later than 1 PM  on Wednesday August 6. It is imperative that each student have a group prior to the first lab on Monday. However, if you do not have a group, we will assign you to one. When you report to the laboratory (214B MEB) at 3:30 p.m. on Monday, August 11^th, look on the bulletin board for the names of individuals in your group.

Notable Quotes:

"What we learn from the dead is for the benefit of the living."  unknown

"You will have to learn many tedious things … which you will forget the moment you have passed your final examination, but in anatomy it is better to have learned and lost than never to have learned at all."  W. Somerset Maugham, Doctor of Medicine (1874-1965)

"Doctors without anatomy are like moles. They work in the dark and the work of their hands are mounds."  Tiedemann (1781-1861).