Medical Gross Anatomy - Introduction to Gross Anatomy

This subject provides an introduction to anatomical and medical terminology and basic information on form and structure fundamental to considerations of function, physical diagnosis, trauma and disease in support of the medical curriculum. Realizing that medicine deals with the human body in all of its manifestations and realizing that neither student nor faculty can determine the ultimate use to which this information will apply for each individual, it is the object of the anatomy sessions to provide a broad coverage of gross structure so far as the time allows.

It is the objective of the anatomy sessions to expose the student to the various details underlying the ensuing curriculum. Following this comprehensive exposure, the student, with minimal review, should be able to recapture their knowledge and understanding as they need it.

Educational Philosophy and Practice

The design of gross anatomy sessions is based upon the educational principles of active learning. These principles are summarized in "The Learning Pyramid". Formal lectures have been eliminated, so that students are able to spend more time in the gross anatomy laboratory, where the highest quality learning takes place. Elimination of lectures places the responsibility on the learner to prepare for dissections. You will gain the most from coming to lab having read the material for that day's dissection, and conversely, it will be a waste of your valuable time to come to class unprepared. Dissection of the human body, peer teaching and learning, and self-directed active learning are the learning tools for gross anatomy. As seen in "The Learning Pyramid", you will learn best what you teach to others. Peer teaching is a significant portion of gross anatomy. If you approach your peer teaching responsibilities seriously, you and your classmates will benefit.

The cadaver is your best teacher. The person you dissect gave her or his body to you in order to allow you to become a well-trained physician. Use this gift wisely. Most of you will never have another opportunity to learn anatomy through dissection. The time you invest in dissection and learning in gross anatomy will benefit you throughout your career in medicine.

The Lab Manual

This manual is a web-based guide to the dissection of the human body. It is designed to present a logical and ordered sequence of exposures of anatomy which will cause the least destruction of individual parts and yet maintain logical and understandable continuities between adjacent regions of the body. All gross anatomy materials are presented on the web at http://anatomy.med.umich.edu and most sessions will be amplified there with useful links to study aids. Before the beginning of each sequence in the first year, students will receive a handout of the Lab Manual, the Review Items, the Clinical Case, and the Anatomy Tables for the anatomy sessions within that sequence.

There are 32 dissection sessions. It is expected that one session will be completed each day. Each dissection must be completed before continuing to the next. Each dissection in the manual includes the material to be learned and indicates the structures to be identified and sequence in which they are to be observed. It also may present some explanation of how to clean and expose structures, or list specific anatomic structures, characteristics, or relations to be observed. Underlined boldfaced text will be used when introducing specific structures to be identified for the first time.

The lab manual is not a text; however, it is to be used as a guide in preparing for dissection, performing the dissection, and studying after completing the dissection. It may also form a check list to aid in review, since you will need to be able to identify or define any structure given in underlined bold faced type or listed in the Review Items, provided within the lab manual at the end of each session.

Radiology will be introduced early in the curriculum and radiographs are included for each laboratory session. They should be a regular part of your studies of each region. Radiographs will be posted on the viewboxes in the hallway leading to the gross labs as we encounter them. Labeled radiographs and radiology lectures are available on the web for study and review. Radiographs are subject matter for both written quizzes and lab exams.

The Lab Overview

Gross anatomy is best learned in an active way and in the correct context - dissection of the human body. Therefore, lectures will not be given. In previous years, lab overviews of 20-30 minutes were given before each lab. The lab overview was a brief review of the material to be covered in the lab that particular day. In general, the lab overview was intended to prepare the student for the material to be covered in the laboratory, where the anatomy is really learned. As such, the lab overview was not the primary vehicle for the delivery of information in this course, and no new information was delivered in a lab overview that was not otherwise readily available in a more active learning format on the course web site. For those who wish to review the lab overviews from a previous year, the anatomy web site has links to these video files. Because the lab material will not be covered in a lengthy lecture, students must come to lab prepared for the dissection by a review of the web materials. The anatomy web site and the cadaver contain all of the material that you will need to master in order to acquire the secure foundation of human anatomy for your career in medicine.

Peer Dissection and Peer Teaching

The dissection of a single cadaver will be carried out by six students, three working as TEAM 1 and three working as TEAM 2. For a few dissections all six students will work together. The remaining dissections will be performed by either team 1 or 2.

Attendance: Students must be present for every lab assigned to their dissection Team. Failure to participate in assigned dissections will result in an Early Concern letter being added to the absent person's records.

Session 2: Starting with session 2, the teams will alternate dissections as per the schedule. A sample schedule is as follows:

Dissections are done by alternating teams or the whole table as a group as indicated on the schedule. Peer presentations should be brief and to the point, but complete, pointing out ALL structures in bold underline text in the lab manual or in the Review Items list. Comments such as "We could not find that" are not acceptable and should not be accepted by your peers! If it is listed, it must be demonstrated. If you cannot find something, seek the help of your instructor during lab or before the next class. The presenters should:

You will know from the first day of class what dissections you are responsible for. It will be to your advantage not to wait until the last minute to begin preparing for them since in regard to reference materials others may be looking for the same information.

The whole body will be dissected and for the most part all structures demonstrated on both sides. In some areas (you will be given directions when) different structures may be dissected on different sides. For example, the superficial structures may be done on one side of the face, the deep structures on the other, etc. Cooperation is essential in dissection. One dissects while the another assists (reads the instructions from the lab manual or the description from the text). These roles are then reversed, as it is important that each student have the opportunity to dissect his/her share of the time.

Please use the Peer Presentation Evaluation Form to submit anonymous feedback to presenters. Your thoughtful critique will help the presenter to refine her or his communication skills, which are crucial as a healthcare practitioner.

How to Study Gross Anatomy:

Gross Anatomy, as presented here, provides a variety of inputs or methods to assist your learning: dissection, radiographs, computer assisted instruction, movies, availability of laboratory instructors, and texts and atlases (What text and atlas should I use?). Though each of these methods assists in its own specific fashion, the most important is the laboratory dissection. Anatomy deals with structure and no description or illustration can surpass individual observations of the three dimensional structure. The capacity to be observant is essential to clinical diagnosis, and studying anatomy is a good way to develop it.

Individuals differ in their methods of study and their approach to any specific subject. Though a variety of instructional methods are available to accommodate all varieties of individual learning habits, it is not implicit that each student is required to use all of the methods.

Students of anatomy are faced with a subject of great antiquity, a subject that is architectural, structural, dimensional, and descriptive, rather than philosophical. For this reason, students need no special ability other than that of observation. Time and experience improve the capacity to see. Anatomy is also logical. Though the uninitiated at first find this premise difficult, it ultimately becomes apparent.

Studying anatomy should be aimed at discovering the logic and architectural necessities that eliminate the need for rote memorization. Because anatomy is structural, it is a visual science. The dissection and repeated observation of the cadaver become the major mechanism of learning and the mental picture of the anatomy, the goal and reward.

Medical students from previous year's classes have written brief comments on study strategies for gross anatomy. Every student has a unique learning style, and no single approach works for every student, but these comments may help you in formulating your own successful study strategy.

To maximize one's learning, it is essential to have prepared before coming to lab. Preparation is carried out by going over the Prelab Learning Module, Prelab Images, Dissection Videos, and any Learning Modules assigned for a particular lab session. Look for 1) What structures are to be dissected, shape and size? 2) Where are they located? 3) What continuities do they have with structures seen previously? 4) What are the relations of the structures to each other? This preparation is much like studying a road map before taking a trip.

The skeleton exists throughout the body and is the point of attachment or reference for practically all components of the other systems of the body. One should not attempt to learn the individual bones alone, but to learn individual parts and processes as these occur within the context of dissection. These parts have been indicated in the dissections as points to be palpated or major points of attachment or contact of muscle. The bones provided in the lab are particularly useful for this process. In this manner, as with other systems, as a region is completed the skeletal element of that region will also be complete. Systematic review will then integrate the components of the system. Study of bones should be limited to: articulations, major processes of attachment, and major structural characteristics. The skull should be considered as a single integrated structure rather than as a complex of detailed individual bones. Radiographs showing the same landmarks should be reviewed when available as well.

Dissecting is a simple procedure. It is merely the exposure of structures (muscles, arteries, veins, nerves, ligaments, organs, bones) so that their placement, orientation, shape, size and thickness, and their interrelationships with other structures may be readily observed. It is therefore implicit that care must be taken to remove all connective tissue and fat that would obscure this visibility. While exposing structures, or after they are exposed, read the Lab Manual and Dissector Answers so that your observations may be complete and accurate and the details are confirmed. A good plan is to have one of the non-dissectors read the Lab Manual aloud while the others dissect. Simple identification of a structure is not sufficient -- the question to ask is: "What is there about this structure that confirms its identification, i.e. why is it what it is and what is its significance?" Its identity often relates to its continuity and/or relationship to the surrounding structures. Likewise, it is insufficient to see only a 2 cm portion of a structure that may be 20 cm in length. Make sure the structure is completely exposed and cleaned so as to really visualize its anatomy and relationships. It is very important to review at the end of each day's work to fix the material firmly in your mind. When sexually dimorphic structures are dissected, it is important to review the anatomy of both sexes. Upon completion of each day's dissection, follow the procedures for "Care of the Cadaver" that follow.

Faculty will evaluate each dissection and record this evaluation. Repeated substandard dissections at a table will prompt Early Concern letters being placed in the records of the students at that table.

With each lab session, simple clinical cases or vignettes are included in the anatomy web site that will emphasize the anatomy as applied to clinical situations. Use these to make the anatomy more meaningful. For the peer dissections, the presenter will be responsible for presenting the anatomy relevant to the clinical case for that day. You will be responsible for the application of the anatomy that the clinical cases present. You are also responsible for the clinical terms listed in the Review Items. The definitions of these terms may be found on the anatomy web site.

Final study is the correlation of laboratory material, textual description, your own observations and the clinical application. It is only after you have done or have studied the dissection that one can fully appreciate the detailed descriptions and it is at this time that reading the text becomes an excellent review. Ultimately, one should be able to IDENTIFY and DEFINE any structure or term given in underlined boldfaced text in the Lab Manual or Review Items list, be able to tell its significance and relate it to the structures surrounding it. A definition sets the limits or boundaries of a structure and describes its characteristics (such as shape or relation to surrounding structures, etc.) in such a way so as to delineate it from all other structures. Therefore if you can define something, you should be able to identify it and/or describe it. After a region of the body has been completed, a systematic review of each organ system involved will assist in tying together and integrating the region.

Clinical usage of anatomy in many instances implies the ability to perform a physical examination of the living. To facilitate this aspect of anatomy it is important at all times to correlate what is seen in the dissection with what may be seen or palpated on the surface of the living body. Skeletal processes and bones are most readily palpated or seen, while veins, arteries, tendons, ligaments, muscles, organs, contractions, pulses, and other motions may also be observed or palpated.

Palpation of superficial structures is not readily carried out on the cadaver because the tissues and structures are hardened through fixation. Examination of the living should be carried out on yourself, your partner, or other students to confirm all structures that are palpable from the surface. The anatomy web site will review the pertinent surface anatomy for each session.

Guidelines for Help Sessions with Faculty

Faculty are available to answer questions during the regularly scheduled dissection sessions, from 1-5pm. Additional questions concerning medical gross anatomy, either procedural or didactic, should be sent to Dr. Tom Gest.

Faculty will be available to help with questions a four help sessions per week. Faculty will be in the gross labs to answer questions on Thursday and Friday at 8-9am and 12-1pm (Wednesday and Thursday on exam weeks). Additionally, Dr. Walter Castelli and Dr. Sabine Hildebrandt will be in the gross labs from 8:00-9:00 each morning, to answer questions for the early bird crowd. Surprisingly, this crowd is usually quite small, so this is an excellent time to review with an accomplished anatomist. Dr. Lowell Fisher makes most of his non-class time available for office consultation and tutoring. He has been helping gross anatomy students survive the course for many years. He is a great resource for those seeking didactic anatomy tutorial.

Anatomical Variation

A biological variation is a deviation in structure from that of others of the same species. The human body, as in all biological entities, is subject to variation. There are variations that occur between individuals and between sides of the same individual. They occur in all organ systems. Most variations fall into the categories of size, shape, and degree. Patterns of branching of arteries and nerves are common variations. These constitute "normal" structure. The most important and common variations will be noted in the lab manual and should be learned. There are variations that may be considered "abnormal" since these fall into the category of incomplete development and over-development and are called ANOMALIES.

The student must not expect to find all structures exactly as they are described in texts or illustrated in atlases. These volumes present a pattern of anatomy that is considered average within the population. Photographic-type atlases present anatomy as seen in one individual and do not necessarily reflect the most common anatomy.

The anatomy sessions present average anatomy. The student is expected to learn and be examined on average anatomy. It is up to the student to observe, recognize, and appreciate variations when they are found. Clinically, it is important to be aware of and to recognize them when seen, but it is impossible to predict which variations will occur and to what extent in any given individual.

Variations, anomalies, and evidence of surgical procedures should be recorded in the "Dissection Notes" page of the Medical Histories database. The quality of the Dissection Notes will be considered in making the Demigods of Dissection Award.

Introduction to the Gross Anatomy Lab

The white plastic table cover is provided to keep the tables and lab neat and orderly as well as to prevent dehydration. When dissecting or studying, remove only as much of the plastic cover as necessary. In your first lab session, use the sponge to wash away stains, blood, loosened epidermis and the remains of coagulated blood and embalming fluid. The blistered appearance of parts of some cadavers is the result of the epidermis being elevated due to the pressure of the embalming fluid. In some cadavers there may be rectangular areas where the skin has been removed, for skin grafts, etc. The head, hands, and feet are protected by plastic bags. Until we dissect these regions, leave the bags on to prevent desiccation. Additional plastic bags will be supplied for organs as these parts are removed in subsequent dissections. Please note that ALL bone removed during dissection must be placed in plastic bags which must remain on the dissection table (not in the tray below).

A set of tools is provided for each dissection group. They will be found in the tray below your table, at the head end. Please keep your tools clean and handle them with care. When not in use, keep them in the tray under the table, at the head end. Wooden blocks are provided as supports. Keep these under your table when not in use, at the foot/drain end.

At the completion of the each day's dissection, the following procedures should be carried out. Remove all non-bony tissue fragments and place them in the tan fiber bucket on the tray below the cadaver. Clean the table with the sponges provided with your table kit. Moisten dissected regions with Biostat as needed, completely cover the cadaver with the muslin sheet, and moisten the sheet with Biostat. Book stands should be placed on the tray beneath the table between the drain bucket and tissue bucket. The white table cover should then be replaced, taking care to cover the table completely. Instruments should be stored in the tray beneath the table, at the head end. Do not leave instruments on the table, as these present a safety concern. Sharp instruments may become lost beneath the cadaver, and may be encountered much later when the cadaver is being turned, with injury resulting. Care of your table and your cadaver stems from the reverence and respect our body donors deserve.

You may leave your lab coats on hangers in the laboratory when they are not in use. Have your coats cleaned regularly! Name tags will be provided - please attach them in a highly visible location so faculty can learn your names easily. This will also prevent loss of lab coats when left hanging in laboratories. The Netter's Atlas provided for your table should be kept in the small locker assigned to your table group, along with any personal items.

Dispose of all soft tissue removed from the cadaver (skin, fat, tissue fragments, etc.) in the tan fiber bucket under your dissecting table. Do not put paper, gloves, or other waste in these tissue buckets. All bone fragments, major parts, organs, and limbs are to be kept as a unit with the remains of the cadaver.

Dispose of gloves and paper waste in the large green or gray wastebaskets near the sinks. Do not put glass bottles or tin cans in these containers. They may cause serious injuries to the custodians. Used scalpel blades are to be removed with the ClickSmart blade removal devices by the sinks, or carefully removed by hand and placed in the sharps containers near the sinks. Band-aids are found at the sinks, and eyewash stations and emergency showers are located at the center sink in each room.

It is necessary to expose only those areas of the cadaver that are being dissected. This reduces dehydration from the air conditioning and maintains a cleaner and more orderly appearing laboratory. The above procedures should maintain the proper moisture level of the cadaver. If the cadaver shows signs of dehydration, moisten the cadaver with Biostat found in plastic jugs at the sinks. You will be dissecting this cadaver for the whole term and proper care must be taken if it is to be useful for study for the whole term. It is especially important to maintain those parts of the body that are not currently being dissected, as you will come back to them later. Occasionally mold may form on a cadaver, usually in an area previously dissected. If you detect any mold, inform Dr. Gest so that it may be treated.

Computers: There are 32 computers located within the gross anatomy laboratories. There are 8 computers per room, or 1 computer for every lab table. Please share this equipment. Do not handle the keyboard or mouse with dirty hands. Do not unplug or move the computers. Please report any malfunctions or difficulties with the computers to Dr. Gest.

Medical Histories: Information concerning the medical histories of the body donors used in gross anatomy is available on a secure web site through the anatomy web site. The cadavers you dissect are, in a sense, your first patients. You should use the medical histories database to locate cadavers that exhibit examples of pathologies, surgical procedures, and variations. As you dissect your cadaver, you will be expected to enter notes of your observations, so that other students may become aware of any unusual or exemplary anatomy that your cadaver holds.

Demonstration Specimens: Bones and permanently preserved "plastinated organs" (organs impregnated with silicone) are located on shelves within the gross labs and on the demonstration tables in the center of each lab. Please handle these specimens with care and with clean hands only. They should be used only on the clean tables located in the center of the rooms. When you are finished studying them, return them to the appropriate shelf. Bones are fragile. Do not handle them carelessly or drop them. Be especially careful with skulls. Handle the articulated skeletons with care. They, too, are fragile and though they move freely, they should not be forced.

The laboratories are always available to you. You have the privilege of dissecting during unscheduled laboratory periods and should maintain the specimens and equipment in the laboratories. The code access numbers are for students only - keep the code confidential.

The laboratories are for students and those individuals legitimately in the medical field. Your parents or other relatives may wish to see the laboratory, and may do so with the approval of Dr. Tom Gest early in the course; however, they are closed to all other individuals.

NO SMOKING, EATING, DRINKING OR PHOTOGRAPHS ARE TO BE TAKEN IN THE LABORATORIES.

ABSOLUTELY NO ANATOMICAL MATERIAL MAY BE TAKEN FROM THE LABORATORIES AT ANY TIME UNDER ANY CIRCUMSTANCES.

Anatomy Awards

To recognize the table whose students conduct themselves in an exemplary fashion, an award is presented at the end of the year. This is the highly coveted, prestigious Double D or Demigods of Dissection Award. This award is given to the table that demonstrates superior dissection skills, excellent care for the cadaver, and consistent recording of Dissection Notes in the Medical Histories database.

The table that consistently demonstrates superior peer presentations will be given the Triple P or the Premiere Peer Presenter Award.

The Quadruple E or Eagle Eye of Editorial Excellence Award goes to the individual who finds and accurately reports the most number of typos, broken links, and errors in the anatomy web site. In order to be considered, bug reports should be very specific on location and nature of the problem.

The Woodburne and Burkel Outstanding Anatomy Student Award goes to the individual or individuals who demonstrate superior anatomical knowledge and dedication to learning gross anatomy.