Joan C. Edwards School of Medicine - Marshall University, Huntington, WV

2004 GUIDE TO GROSS ANATOMY AND EMBRYOLOGY

COURSE OVERVIEW

   Gross Anatomy is the signature course of medicine in the basic sciences. It also provides a foundation for the language of medicine. Our course in Gross Anatomy and Embryology is based upon a logical sequence of laboratory dissection. The schedule is largely determined by the anatomy of humans, but consideration has been given to the following: 1) dissection skills of students throughout the semester, 2) length of time necessary to dissect and comprehend a particular region, and 3) the relative general clinical importance of a given region.

   Directly correlated with a particular laboratory session is a specific reference to pages in Grant's Dissector. THIS DISSECTOR IS THE DETAILED SYLLABUS FOR THE COURSE. You need to be able to recognize and recall pertinent anatomical information given there. It will benefit you to study Grant's Dissector repetitively and in detail. This is especially important if you are not an assigned dissector for a particular region of the body.BR>
   Cadavers are your best resource for learning about the structure of the human body as it relates to medicine. Body donations are selfless acts made with the aim of helping your development as a physician. Dissection is a multiple modality experience that allows you to carry out a semi-independent investigation on the structural organization of the human body. You might consider your cadaver as your first patient. In the process of examining the body in detail through dissection you will discover abnormalities. This is probably the only opportunity you will have to explore a human body in such detail. Use this opportunity wisely to develop important professional attitudes and do the dissection well and in a timely fashion. ALWAYS and IN ALL WAYS treat the cadaver with respect!

   To benefit maximally from dissection, you should read the dissection assignment in Grant's Dissector prior to the laboratory. We expect all assigned dissectors to be in the laboratory during their scheduled dissection periods. You will gain the most from the dissection experience by actively participating in it. The faculty will assist you in understanding the instructions for dissection. You are to carry out the dissection! The faculty are not to do the dissection for you. Even though you are not an assigned dissector for a particular laboratory, you should keep current with the lab assignments and the dissections associated with them.

   We strive to provide an environment, particularly in the laboratory, where you can actively learn the gross anatomy needed for subsequent education in, and 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 you are responsible for may be covered in lectures and handouts. .

   All three texts recommended for the course, Clinical Anatomy, 7^th edition, by R. S. Snell, Clinically Oriented Anatomy, 4^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. Several times throughout the semester appropriate page assignments are made in the embryology text, Langman's Medical Embryology, 9^th edition (T. W. Sadler, editor). Read the appropriate lecture notes and the assigned pages prior to the lecture. Due to time constraints, not all of the material in the embryology text is discussed in the course. The topics covered in the course are more important clinically and assist you in understanding structural and functional relationships in the adult.

COURSE OBJECTIVES

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.
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.
To provide exposure to the range of variability included in normal human anatomy.
To nurture professional attitudes towards patients, colleagues and others.
To reinforce professional ethics and behavior.
To foster the development of a level of self discipline and self confidence sufficient to permit independent learning.
To aid in the attainment of adequate study skills.
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://www.musom.marshall.edu/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 dissection, peer-teaching, peer-learning, and with faculty.

TEXTS AND EQUIPMENT

Required synopsis:
Tank, Patrick W., Grant's Dissector, 13^th ed., ISBN 0-7817-5484-8.

Recommended gross anatomy texts (choose one of the three):
   Snell, R. S., Clinical Anatomy, 7^th ed., ISBN 0-7817-4315-X, OR
   Moore, K. L., and A. F. Dalley, Clinically Oriented Anatomy, 5^th ed., ISBN 0-7817-3639-0, OR
   Drake, R. L., W. Vogl, and A. W. M. Mitchell, Gray's Anatomy for Students, 1^st ed., ISBN 0-443-06612-4.

Recommended embryology text:
   Sadler, T.W., Langman's Medical Embryology, 9^th ed., ISBN 0-7817-4310-9.

Recommended Atlases: choose one of the following; note that the first 3 are referenced in Grant's Dissector:
   Agur, A. M. R. and A.F. Dalley, Grant's Atlas of Anatomy, 11^th ed., ISBN 07817-4255-2, OR
   Netter, F.H., Atlas of Human Anatomy, 3rd ed., ISBN 192900711-6, OR
    Rohen, J. W., C. Yokochi, and E. Lutjen-Drecoll, Color Atlas of Anatomy: A Photographic Study of the Human Body, 5^th ed., ISBN 0-7817-3194-1, OR
   Abrahams, P. H., S. C. Marks, Jr., and R. T. Hutchings, McMinn's Color Atlas of Human Anatomy, 5th ed., ISBN 0-7234-3212-0, OR
   Moses, K.P., J.C. Banks, Pedro B. Nava, and D. Petersen, Atlas of Clinical Gross Anatomy, 1^st ed., ISBN 0-3230-3744-5.
   The Netter Atlas of Human Anatomy, 3^rd ed., is available in a Combo-Pack with an interactive CD, the Netter Interactive Atlas of Human Anatomy, the Student Combo-Pack ISBN is 1929007582.

Software (suggested for your perusal and available either on DITMI computers, or the laboratory computer, or from Mr. Cook)
   Cross-Sectional Anatomy - A Gallery of Images (utilized during the course)
   Interactive Atlas of Clinical Anatomy, Netter
   A.D.A.M. Interactive

Video Cassette Tapes
   Several titles are available from Mr. Cook in the laboratory and are referenced in the appropriate handouts. Ones you might particularly consider for their step-wise approach are Acland's Video Atlas of Anatomy. There are 6 videos in Acland's covering various regions of the body.

Web sites
   A web site devoted to the course is at http://musom.marshall.edu/anatomy/grosshom/
Dr. Zill's lecture slides and handouts are available at http://meb.marshall.edu/anatomy/grosshom/headneck.html
Dr. Berk's lecture slides are available at http://musom.marshall.edu/anatomy/grosshom/berk_slides.html
Dr. Berk has also prepared practice practical exams which can be found at http://musom.marshall.edu/anatomy/grosshom/practicals.html
Other web sites are referred to during the course and students are encouraged to explore anatomy and embryology web sites on their own.

Lumen Learn ‘Em http://www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/learnem/learnit.htm is free and may be helpful for learning muscles and for self-testing and reviewing. It includes areas on arteries, bones, cutaneous innervation, dermatomes, muscles, and nerves.

The University of Michigan has several learning resources available via the internet. Learning Modules, http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/courseinfo/module_index.html, deal mainly with the nervous system, especially the autonomic nervous system, but there are modules on anatomical orientation, development of the gut, and joints. Atlas images, with labels for some parts of regions are available at http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/atlas/atlas_index.html. These too, are heavy on the nervous system, but there is some regional coverage you may find helpful. There are also Radiology images, some of which are labeled, at http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/radiology/xray/xray_list.html. You may find the Clinical Cases area to be informative, as well as interesting, go to http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/courseinfo/clinical_index.html. The Tables section http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/anatomytables/anatomy_tables.html mimics the one at the University of Arkansas (same author, see below). The site also has a limited amount of material on regional surface anatomy at http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/surface/index.html You may find the Quizzes at http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/courseinfo/mich_quiz_index.html to be helpful, and you might even enjoy the Crossword Puzzles at http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/crosswords/crossword_index.html.

The Department of Anatomy at the University of Arkansas for Medical Sciences http://anatomy.uams.edu/anatomyhtml/medcharts.html has some learning resources online. These include tables of muscles, nerves, arteries, and more, and atlas images for some regions.

Required Equipment and Supplies

   Dissecting Instruments
   Two sets of the necessary dissecting instruments are required for each dissection table. The dissection kits, plus a Grant's Atlas and Grant's Dissector, are rented to you by the Department. Additional scalpel blades will be required and can be purchased from Mr. Cook in the laboratory for $0.35 each or 3 for a $1 or at the bookstore.

   Laboratory Coats for dissecting
   Each student must wear a lab coat during dissection! Unprotected clothing you wear in the lab may be rendered generally useless for many social occasions. You may wish to reserve some clothes for use only in the lab. The Department makes lab coats available during the Introduction to Gross Anatomy session. If the departmental supply of lab coats is exhausted, students must provide one. Students who want their own lab coat may purchase one in the bookstore. Wear your name tag on your laboratory coat so your faculty and classmates know who you are.

   Gloves for dissecting
   Dissection 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 dissecting! The gloves can be disposable examination or surgical gloves or non-disposable flexible gloves (such as used for dishwashing). Disposable latex or other exam-type (vinyl, nitrile) gloves are suitable and provide adequate sensitivity. Examination gloves can be purchased from Mr. Cook in the laboratory (latex & vinyl, $6/box; nitrile, $8.00/box).

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. Similarly, there are some additional instruments that would be helpful at times. However, these are not necessary as all dissections can be done with the rented dissection kits and the other instruments provided.

Pregnancy

   If you are pregnant or become pregnant during the course, you must take additional steps to protect the well being of your 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. Rhoten. 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 will find this to be a welcome relief as the mask is confining and uncomfortable. 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 cadavers with respect at ALL times, wearing a lab coat, gloves and a name tag In the laboratory.
   Dissections and/or cadavers MUST NOT BE DISCUSSED IN PUBLIC PLACES.
   Eating, drinking and smoking are prohibited in the laboratory and food, beverages and tobacco products should not be brought into the laboratory.