Use of Technology in a Gross Anatomy Course

1. Use of Technology in a Gross Anatomy Course (Or how to use everyone else’s great ideas!) Terence P. Ma, Ph.D. Director of Gross Anatomy; Director of Technology William A. Roy, Ph.D. Gross Anatomy Faculty Touro University Nevada College of Osteopathic Medicine Henderson, Nevada

2. Students atTouro University Nevada • August 2004 – First DO class (78 students) • August 2006 – Third DO class (138 students) • Current students (690 total): DO, PA, Nursing, OT, Education

3. First Year Medical School Curriculum (2006-2007; 2007-2008) • First Semester: • Introduction to Biochemistry and Tissues • Gross Anatomy and Embryology • Basic Science Foundations I • Systems-based integrated course in biochemistry, physiology, and microscopic anatomy • Osteopathic Manipulative Medicine • Physical Diagnosis • Public Health • Introduction to Clinical Medicine • Second Semester • Gross Anatomy and Embryology (carryover) • Medical Neuroscience • Basic Science Foundations II • Osteopathic Manipulative Medicine • Physical Diagnosis • Introduction to Clinical Medicine • Medical Jurisprudence • “PBL” (Case-based team learning)

4. Evolution of theGross Anatomy Course

5. Dissection Through the Ages

6. Physical Features of the TUN Gross Anatomy Laboratory • Space for 34 Dissection Tables • For 2006-2007: • 137 Students • 5 Faculty • 1 Laboratory Manager • Temperature: 60˚ – 65˚ F (~15˚ – 18˚ C) • Humidity: 60-70% • Air Exchange: • Negative pressure room • Downdraft ventilation • 14 – 18 per hour • Hard floors, anti-mould ceilings and walls • “Natural” fluorescent lighting • (Note: Just changed to “All Spectrum” lighting)

7. Fundamental Learning Unit: Dissection Table Teams • Each team consisted of 4 or 5 students • Teams were changed every unit • Student were told “random” assignment (True for first unit.) • Actual assignment pseudo-randomly based on exam scores and former teams • Students dissected a different cadaver every unit • Student grades on class activities (small groups, dissection reports, clinical case presentations) were based on the team (all members of the team got the same grade)

8. Using Technology Within the Gross Anatomy Laboratory • University Technology • University is completely wireless (802.11ag) • Ability for faculty to set up secured websites for educational purposes • Adobe/Macromedia software available to faculty • Concerns in Laboratory • Wet, greasy, dirty • Harsh chemicals (formaldehyde, phenols) • Ability for students to access electronic resources and be useful educationally

9. Computer Specifications • Slate-Style Tablet PC • Not desktop • No mice or keyboards! • Not convertible-style Tablet PC • No moving parts! • Requirements • Pentium Processor • 12.1” High resolution monitor • 1 Gbyte of RAM • 30 Gbyte HDD • 802.11ag Wireless • Microsoft Windows XP Tablet PC Edition • Microsoft Office Professional • Microsoft OneNote • Motion Computing LE1600 • For the IT Curious: • 3 Required re-seating of HDD • No other problems encountered

10. Gross Anatomy Website

11. Dissection Instructions with Modified Figures from Textbook Images from Drake et al. Grays Anatomy for Students

12. 2006-2007:Provided at Each Dissection Table (And electronic images from these and other atlases [as available].)

13. Virtual Dissections forAxial Anatomy • Virtual dissections of the US Visible Human project • Ability to look at individual axial sections as well as reconstructed body

14. Expected Use of Tablet • Student Use • Dissection Instructions • Images from textbook • Image banks from other atlases • VH Dissector program • Image banks from radiological files • Daily summaries of dissection • Faculty Use • Testing purposes • (Note: To facilitate faculty getting used to using these devices, each gross anatomy faculty was assigned a tablet of their own.)

15. Identify (specific; at tip of arrow)

16. Which vertebra? (Be specific)

17. Clinical Case Presentations • Each dissection table team has to identify a diagnosis that they want to talk about • Students had to invent a patient to present • Presentation delivered to a faculty member (could be gross or clinical faculty) • Must discuss gross anatomy and changes in the clinical syndrome • Must show radiological images (OK to show normal) • Must be able to answer questions from classmates (and faculty) • All students at table got the same score

18. Small Groups • 15 small groups • 2 or 3 dissection tables per small group (8-12 students) • One each week for students (faculty did four) • Group activity and groups were to report the results of their discussions to the other students in the small group • Before unit exam, it was an “open” review • Chose topics that were cut from clinical lectures • Gave quizzes (sample exam questions) • Attendance was required and received one percentage point towards final grade for each session • Except for quizzes, all students in the group received the same grade

19. “Oh my!” …On the SECOND Visit! • An 18-year-old male visits your office for a second visit two weeks after sustaining a compound fracture of his right tibia and emplacement of a cast • The patient’s leg seems to be improving • The patient tells you that he didn’t like using the cane as you had instructed and decided to use one of his older brother’s crutches from several years back • However, the patient is complaining of right sided upper limb symptoms: • Tingling sensations down the medial side of the arm and forearm • Tingling and shooting pains down the posterior side of the arm and forearm extending into the lateral hand • Difficulty extending the arm at the shoulder, forearm at the wrist, and the fingers and thumb • What nerve(s) do you think are affected? Where is this problem located? How did the patient injure himself? What is the prognosis? SAMPLE CASE STUDY

20. Other Small Groups • Given a case history, research (using on-line and textbook resources) the differential diagnosis (in group, in session) and explain the likelihood of the diagnosis • Given a diagnosis, research (on-line) the diagnosis and “create” a patient with that diagnosis

21. Outcomes 1 • Few relevant hard numbers, too many variables • Use of computers in the lab: • The students used the computers regularly • They really liked the dissection manual, especially since they could download it and annotate ahead of time • They were surprised that not all institutions used tablets (or at least computers at every station) • They liked the ability to have resources in the lab and be able to access everything available electronically to them in the lab (only problem is that the lab was too cold) • They liked being able to write the reports in the lab on the computer • We want to expand this functionality into the future

22. Outcomes 2 • Clinical case presentations • Students get first taste of making public presentations about medical topics • Initially high stress • Promotes team activities on a longer term • Students really like this activity • Quality of presentations and time spent in preparing was very high • Small groups • Unanimously the most liked activity in gross anatomy • Students requested more sessions • Taught gross anatomy, reasoning, research of resources, and encouraged peer-to-peer activities • Students were of the opinion that they learned more from small groups than other activities • Modification for 2007-2008: • Introduction of Audience Response System to lectures and other activities