MEDICAL EDUCATION

Improved Dissection Efficiency in the Human GrossAnatomy Laboratory by the Integration of Computers

and Modern Technology

RUSTIN E. REEVES,* JOHN E. ASCHENBRENNER, ROBERT J. WORDINGER, ROUEL S. ROQUE,AND HAROLD J. SHEEDLO

Department of Cell Biology and Genetics, University of North Texas Health Science Center, Fort Worth, Texas

The need to increase the efficiency of dissection in the gross anatomy laboratory has been thedriving force behind the technologic changes we have recently implemented. With theintroduction of an integrated systems-based medical curriculum and a reduction in laboratoryteaching hours, anatomy faculty at the University of North Texas Health Science Center(UNTHSC) developed a computer-based dissection manual to adjust to these curricularchanges and time constraints. At each cadaver workstation, Apple iMac computers wereadded and a new dissection manual, running in a browser-based format, was installed. Withinthe text of the manual, anatomical structures required for dissection were linked to digitalimages from prosected materials; in addition, for each body system, the dissection manualincluded images from cross sections, radiographs, CT scans, and histology. Although we haveplaced a high priority on computerization of the anatomy laboratory, we remain strongadvocates of the importance of cadaver dissection. It is our belief that the utilization ofcomputers for dissection is a natural evolution of technology and fosters creative teachingstrategies adapted for anatomy laboratories in the 21st century. Our strategy has significantlyenhanced the independence and proficiency of our students, the efficiency of their dissectiontime, and the quality of laboratory instruction by the faculty. Clin. Anat. 17:337–344, 2004.© 2004 Wiley-Liss, Inc.

Key words: human anatomy dissector; digital images; browser-based; integratedcurriculum; system-based

INTRODUCTION

In the fall of 1999, the University of North TexasHealth Science Center (UNTHSC) changed from atraditional course-based curriculum to a system-basedone wherein first-year medical students received anintegration of anatomy, embryology, physiology, andhistology based on individual body systems. From thefall of 1998, which was the last year that human grossanatomy was taught as a separate course, to the fall of2001, representing the beginning of the third yearunder the new curriculum, the number of laboratoryhours devoted to the teaching of human gross anat-omy was reduced approximately 24% (Table 1). Asreported by Aziz et al. (2002), a result of medicalschool curricular reform over the past 20 years hasbeen a drastic reduction in time, form, and content ofanatomic instruction. With our laboratory hours re-

duced, there became an immediate need to streamlinethe dissection component of the anatomy curriculum,making it more efficient and more conducive to stu-dent participation, interest, and learning. To meet thisneed we implemented a “technologic overhaul”: inmany U.S. medical schools during the past decadecomputers have been used in the anatomy laboratoryas a supplemental teaching aid for course material; buttheir use as an integral component of the dissectionprocess has been limited.

*Correspondence to: Dr. Rustin E. Reeves, Department of CellBiology and Genetics, University of North Texas Health ScienceCenter, 3500 Camp Bowie Blvd., Fort Worth, TX 76107.E-mail: rustyr@hsc.unt.edu

Received 14 June 2002; Revised 10 September 2003

Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ca.10245

Clinical Anatomy 17:337–344 (2004)

© 2004 Wiley-Liss, Inc.

In the 83 U.S. medical schools responding to asurvey conducted by Drake et al. (2002), the averagehuman gross anatomy course consisted of 176 � 39total hours. The laboratory component comprised 70%(�120 hr) or more of the course in 40% of the schools.At the UNTHSC, the anatomy course consists of 109total course hours; the laboratory currently represents69% of our total course hours, down from 80% in 1990(Table 1). During the past 12 years at UNTHSC thenumber of laboratory hours devoted to human dissec-tion has been reduced significantly: in the fall of 1990there were 140 laboratory hours and in 2001–2002there were 75 hours. This 46% drop in the number oflaboratory hours, without any significant reduction inthe required course material, necessitated the devel-opment of an innovative instructional tool, one that

would maintain the academic integrity of the coursewhile increasing laboratory efficiency.

The decision was made to develop a dissectionmanual that would not only fit our new curriculum,but would also be in accord with emerging trends andinstructional methods used to teach cadaver dissec-tion. These trends have shown a gradual but steadyreduction in contact hours (Cottam, 1999), which hasbeen driven frequently by medical school curricularreform committees that have often, and sometimesjustifiably so, allotted additional time to pharmacol-ogy, microbiology, immunology, biochemistry, andmolecular biology. As noted by Drake (2002), therelevance of clinical medicine to the basic sciences isundergoing a major reevaluation, resulting in reducedcourse hours for the basic sciences. Another trend

TABLE 2. List of Structures Not Required for Dissection in the New Browser-based Dissector

System-basedcurriculum Region-based curriculum Structure

Musculoskeletal Deep back Some of the deep back muscles, such as the transversospinalis m.aMusculoskeletal Pectoral region, axilla, upper extremity Ligaments of the shoulder, elbow, and wristsb

Musculoskeletal Gluteal region, thigh, knee, leg, ankle,and foot

Lymph nodes, genicular arteries at the knee, malleolar arteries,ligaments of the anklec

Nervous Head and neck Tarsus of eyelid, lacrimal nerve, nasociliary nerve, anteriorethmoidal nerve, ciliary ganglion, superior ophthalmic vein

Nervous Head and neck Supraclavicular nerves, masseteric nerve and vessels, cervicalsympathetic gangliab

Nervous Head and neck Nasopalatine nerve, anterior ethmoidal nerve, sphenopalatineforamen and ganglion, nerve of the pterygoid canal, oticganglion, submandibular duct and ganglionb

Cardiopulmonary Thorax Branches of lateral cutaneous nerves, bronchiopulmonarysegments, lymph nodes at tracheab

Gastrointestinal Abdomen Hepatic and pancreaticosplenic lymph nodesb

Abdomen (posterior wall) No changesUrinary/reproductive Pelvis and perineum Perineal body, suspensory ligament of the penis, greater vestibular

glandb

aThese structures are shown and discussed in the browser-based dissector.bThese structures are covered in lecture and accessed on written exam.cThese structures are studied on prosected cadavers in the laboratory.

TABLE 1. Laboratory Hours at UNTHSC From 1990–2002

Anatomical region (old curriculum) Body system (new curriculum)

Lab hours

1990 1995 1998 2001–2002a

Back, scapular and pectoral region Musculoskeletal/skinsystem 12 10 12 7Upper limb Musculoskeletal/skin system 16 15 12 11Head and neck 1 Nervous system 18 15 12 9Head and neck 2 Nervous system 18 15 14 9Thorax Cardiopulmonary system 18 15 12 7Abdomen Gastrointestinal system 18 14 10 9Posterior abdominal wall and kidneys Renal system 6 5 4 5Pelvis and perineum Reproductive system 18 15 10 9Lower limb Musculoskeletal/skin system 16 15 12 9Total laboratory hours Total laboratory hours 140 119 98 75Total course hours 176 109Laboratory/total course hours, % 80 69

aAnatomy taught in the system-based curriculum covers the entire academic year. The other years indicate the discipline-basedcurriculum where anatomy was taught in the fall semester only.

338 Reeves et al.

reported by Cottam (1999) was an increase in theinstructional use of computers. Based on these partic-ular trends, and after many hours of debate among ouranatomy faculty, the format for a new browser-baseddissection manual was agreed upon and the develop-ment phase of the project began: our primary focuswas the articulation of clear and concise directions fordissection, with the ultimate goal of increasing signif-icantly the productivity of students during their dis-section time.

MATERIALS AND METHODS

Browser-Based Dissection Manual

As the dissector browser-based text progressed tofinal form, digital images of pertinent prosected ca-daveric anatomic structures were taken with a NikonCoolPix 990 digital camera, edited using Adobe Pho-toshop 6.0, and catalogued; Netter illustrations fromIcon Learning Systems (Teterboro, NJ) were pro-cessed; scanned images of cross sections and radio-graphs were modified; and digital histologic imageswere taken with the Nikon CoolPix 990 cameramounted to a Nikon Labaphot microscope. Dream-weaver 3.0 web development software was used to

develop the browser-based dissector and then link thecompressed digital images of anatomical structures,Netter illustrations, radiographs, cross sections, andhistological structures within the text; a graphic artistin the Department of Biomedical Communicationsdesigned computer-generated diagrams of anatomicincisions. In addition to a browser-based dissectionmanual, a printed dissector was developed usingQuarkXPress 4.1 editing software. The printed dissec-tor included clinical notes of relevant anatomical re-gions, dissection procedures, and review checklistspertaining to each body system.

Computer-Based Dissection Workstations

Apple iMac computers (Apple Computer, Cuper-tino, CA) were placed on Ultra 300 Computer MonitorSupports (ICWUSA.COM, Inc., Central Point, OR), acomputer wall-mount specifically designed to con-serve floor space. Each of the 26 cadaver workstationsconsisted of a stainless steel cadaver tank, a computerand a wall-mount stand. The computers were pro-grammed with specially designed “loading package”software developed by the anatomy faculty and staffas well as the Information Technology Services De-partment at UNTHSC. This package allowed stu-

Fig. 1. Human gross anatomy laboratory at UNTHSC showing iMac (Apple) computers loaded withthe new browser-based dissector at each cadaver workstation. [Color figure can be viewed in the onlineissue, which is available at www.interscience.wiley.com.]

Integrating Computers With Dissection 339

dents to access only particular components on thehard drive. For practical examinations, an administra-tor site, accessible only by password was used to ac-cess the hard drive to download programs containinghistologic images, X-rays, CT scans, and cross sec-tions.

Evaluation of Dissector Format and Components

A survey was conducted in March of 2002 by theanatomy teaching faculty to determine dissector for-mat and component preferences by medical and grad-uate students. A summary measure, the Strength In-dex (SI), was calculated from the percentage ofstudents responding strongly agree (SA), agree (A),neutral (N), disagree (D), or strongly disagree (SD) toeach statement. The formula used to calculate the SIis ((SA � 5) � (A � 4) � (N � 3) � (D � 2) � (SD �1)/SA � A � N � D � SD) � 20. The SI has a rangeof 20–100, with 100 considered maximum satisfaction.

RESULTS

The first phase in the development of our browser-based dissector guide was for each anatomy faculty

member to write precise and succinct dissection proce-dures for their region or system of expertise, mindful ofthe time allotted for each dissection and the structuresassigned. For the most part, the assigned structures fordissection in the new dissection guide were very similarto those under the old curriculum. The main modifica-tions were to the dissection procedures; however, a fewstructures that were difficult to find were eliminated.Table 2 shows the structures not required for dissectionin the current curriculum compared to the previous one;for example, in the Musculoskeletal/Skin System, stu-dents are not required to dissect some of the deepestback muscles. These muscles, however, are shown anddiscussed in the browser-based dissector and on pro-sected cadavers. For all laboratory sessions, clinicallysignificant structures were stressed. Upon their comple-tion in the fall of 2000, the new dissection procedureswere given to students in handout form for use in as-signed laboratory exercises instead of the previouslyused published dissector. During the spring and summerof 2001, the handouts were compiled to form a boundversion entitled A Synopsis of Dissection for Human GrossAnatomy.

Fig. 2. The student in the background, looking at the computer screen, is answering a histologyquestion during a combination gross anatomy-histology laboratory practical examination. [Color figurecan be viewed in the online issue, which is available at www.interscience.wiley.com.]

340 Reeves et al.

The main goal of the second phase of the projectwas to develop a computer-based format for our dis-section procedures with anatomical images linked

within the text. Our objectives were: 1) to make thefinal product user friendly, and 2) to include images ofstructures similar to what the students would actually

Fig. 3. Students observed in the gross anatomy laboratory during unscheduled hours, using thecomputer-based dissection guide and images as they review for an upcoming laboratory practicalexamination. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]

TABLE 3. Results of Student Survey on the New Browser-based Dissector

Browser-based dissector survey questionsMedical

student SIaGraduate

student SIa

1. The split screen computer dissector used in the Gastrointestinal System I anatomylaboratory was an improvement over the single screen (image or text) dissector used in theMusculoskeletal, Nervous, and Cardiopulmonary System I laboratories.

96 95

2. The Netter illustrations linked within the anatomy dissector to specific anatomicalstructures are a useful and effective teaching tool in the dissection of the human cadaver.

95 93

3. The browser-based format for the computer dissector was easy to learn and to use fornavigating within the dissector program, and provides a useful mechanism for dissectingthe human cadaver.

90 85

4. Labeled X-rays, CT scans, and cross sections incorporated into the computer dissector areimportant and relevant additions to the dissector program for teaching human grossanatomy.

89 84

5. I prefer having histological slide preparations (with descriptions) for the GastrointestinalSystem provided on the computer dissector in the gross anatomy laboratory in addition tothose provided on a separate CD program (or atlas) in the library.

90 95

aA summary measure, the Strength Index (SI), is calculated from the percentage responding strongly agree (SA), agree (A), neutral (N),disagree (D), strongly disagree (SD) to each statement. The formula for the SI is: ((SA � 5) � (A � 4) � (N � 3) � (D � 2) � (SD �1)/SA � A � N � D � SD) � 20. The SI has a range of 20–100 where 100 is maximum satisfaction.

Integrating Computers With Dissection 341

see in their dissection. A web-page development soft-ware, Dreamweaver 3.0, that was used to develop theonline curriculum for the anatomy department, wasused for our browser-based dissector. This softwarecreated a final product that was very user friendly,thus accomplishing our first objective.

Since 1999, high-resolution digital images of ana-tomical structures had been photographed and pro-cessed by our anatomy faculty. As we began to accu-mulate images of prosected cadavers, a naturalevolution of the dissector project began to emerge.The use of these digital images in a dissection manual,linked to our recently revised text document, wouldachieve our second objective. During the summer of2001, our anatomy faculty linked hundreds of imageswithin the browser-based dissector. During this time,the anatomy laboratory at UNTHSC was undergoingextensive renovation with Apple iMac computers in-stalled at every cadaver workstation (Fig. 1). Begin-ning in the fall of 2001, students could now accessthese images during their laboratory dissection time toview assigned structures before dissection. Illustra-tions from the Netter atlas were also linked to desig-nated structures in the dissector text.

In addition to a dissection aid, the computers wereused to display histology images during combinedgross anatomy and histology laboratory practical ex-aminations (Fig. 2). From the viewpoint of the facultyand students, it was convenient to test both anatomyand histology during the same examination period.The high quality achieved with digital histologicalimages viewed on a high resolution computer monitorfar exceeded the quality of 2 � 2 slides viewed in alarge classroom or auditorium. Moreover, structurescould be labeled on the image rather than using a laserpointer to indicate structures viewed on a projectionscreen. The use of computers for testing histology hasseen a marked increase in recent years (Cotter, 2001;Heidger et al., 2002). Our experience has shown thatcomputers are a very convenient and effective formatto display anatomical cross sections and X-rays, as wellas a useful tool for students to review course material(Fig. 3).

In a survey conducted in March 2002, first-yearmedical students found navigation through the dissec-tor easy to learn and scored the browser-based formata high Strength Index (SI) of 90 (Table 3). In addition,the medical and graduate students were asked aboutscreen format preferences and other components ofthe dissector. Students during the 2001–2002 aca-demic school year used two different screen formats.The first screen format had either text or an image onthe screen, but not both simultaneously. This formatwas tested in three different systems: the Musculo-

skeletal/Skin, Nervous, and Cardiopulmonary. RouelRoque, M.D., an anatomy faculty member at UN-THSC, developed a split screen format for the dissec-tion procedures of the Gastrointestinal and Renal Sys-tems. Students could read and scroll through text onthe left frame of the computer screen and view imageson the right frame. When asked to compare the twoformats, both first-year medical students and graduatestudents responded positively to the split screen for-mat with a 96 and 95 Strength Index, respectively(Table 3). Students also responded favorably in thesurvey to the other components of the study guideincluding: 1) linked images of illustrations of the Net-ter atlas, 2) separate sections of labeled X-rays, CTscans, and cross-sectional anatomy, and 3) a separatesection of histological slide preparations as an inte-grated review component for each system (Table 3).

The original browser-based dissector has evolvedinto a computer-assisted educational tool, now calledAn Integrated Approach to the Study of Human Anatomy.Students first open to a directory page with a list of allthe body systems and the histology component (Fig.4A). The directory page is linked to the home page foreach body system (see Musculoskeletal System, Fig.4B). From the systems page, students can choosedissection procedures (Fig. 4C), images of X-rays andCT scans (Fig. 4D), cross-sectional anatomy (Fig. 4E),and system-relevant histology images with descriptivetext (Fig. 4F).

DISCUSSION

In a 1998 survey of U.S. and Canadian medicalschools, 87% of 47 schools responding reported thatthey used computers to teach gross anatomy (Fitzhar-ris, 1998). Cottam (1999) reported that the use ofcomputer-based learning in anatomy education hadincreased 57% from 1991. Cottom (1999) reported asignificant increase in the use of radiographs, MRIs,CT scans, and cross sectional anatomy in anatomycourses. At UNTHSC we deemed the computer aperfect medium for the delivery of complementaryeducational aids in anatomy, such as radiology, crosssectional anatomy and digital images of prosected ca-daveric structures, as well as a highly efficient meansof portraying dissection procedures linked to anatomicimages. As noted by Reidenberg and Laitman (2002),we are in an age of extraordinary anatomic expansion,witnessed by an explosion of new imaging methodsused to visualize structures.

With the advent of a curriculum change and timeconstraints, the level of comprehension by studentsfor specific dissection instructions had to increase.The lists of structures assigned to students had to be

342 Reeves et al.

Fig. 4. Students open the integrated computer-based anatomystudy guide to a directory page (A) that is linked to each system’shome page (B). From this page, students can then navigate to dissec-tion procedures (C), images of X-rays and CT scans (D), cross-

sectional anatomy (E), and system-relevant histology images withdescriptive text (F). [Color figure can be viewed in the online issue,which is available at www.interscience.wiley.com.]

Integrating Computers With Dissection 343

adjusted to those of major structural and clinical im-portance. Further, a novel computer-based productintegrating dissection procedures into the anatomylaboratory experience had to be in a user-friendlyformat for both faculty and students. And finally, stu-dents had to accept the product as an applicable anduseful teaching tool relevant to their training as futurephysicians. The development of our computer-basedanatomy dissector and study guide has proven to usthat the use of technology can directly address each ofthe above-mentioned issues.

Adding computers was necessary at UNTHSC forreorganization and enrichment of the gross anatomylaboratory experience, the force driving the techno-logic changes we implemented. Although we haveplaced a high priority on computerization of the grossanatomy laboratory, we remain staunch advocates ofthe importance of cadaver dissection in anatomy ed-ucation; the computer as part of the dissection processshould never replace the cadaver dissection experi-ence.

The national trend of reduced laboratory hours forgross anatomy instruction in U.S. medical schoolsshould cause anatomy faculty to rethink their teachingstrategies for this essential course. With dissectionremaining at the core of first-year medical students’anatomical training throughout the U.S., efficiency ineach laboratory setting is a must. It is our belief thatthe combination of computers with dissection is anatural evolution of technology and the creativeteaching strategies specifically adapted for humangross anatomy laboratories in the 21st century.

ACKNOWLEDGMENTS

We would like to thank L. Oakford, Ph.D., Depart-ment of Cell Biology and Genetics, UNTHSC, and T.

Delozier, Information Technology Services, UN-THSC, for their assistance with laboratory computersetup and development of the “loading package” soft-ware for the iMac computers. We would also like tothank the staff in Medical Arts, Department of Bio-medical Communications, UNTHSC, for their assis-tance with drawings within the dissection manual. Aspecial thanks is extended to ICON Learning Sys-tems (Teterboro, New Jersey) for supplying us withthe illustrations from the Netter Atlas of Human Anat-omy used in our laboratory version of the browser-based dissector.

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