Posted by: barn owl | February 11, 2008

Tuesday Teaching: Prof-in-a-Box for Medical Gross Anatomy

ResearchBlogging.org
To address the health care needs of an expanding population, medical and dental school enrollments in the US increase every year; however, the number of basic sciences faculty willing and able to teach core anatomical disciplines (gross anatomy, neuroscience, embryology, histology) has not kept pace. Faced with the retirement of the most experienced instructors, and an impending (if not immediate) shortage of qualified teaching colleagues, medical and dental school anatomy faculty have begun to develop alternative educational methods for their most time-intensive courses. For example, our gross anatomy lab sessions last between three and six hours each, and each faculty member is responsible for assisting and instructing 25-30 students with their cadaver dissections. To add to the preparation time required, even if an instructor did not give the lectures on that particular day, he or she is nevertheless responsible for the content and discussion of the relevant material.

Moorman (2006) describes application of distance-learning technologies to medical gross anatomy teaching, such that students studying a prosected cadaver could gain access to an anatomy instructor at a remote site. The author acknowledges that anatomy is best learned in the dissection lab, where structures and their spatial relationships can be observed in situ, in a human cadaver. Moreover, the dissection lab, with assistance from faculty, engages students with differing learning styles, including visual, auditory, and kinesthetic modes. To retain the benefits of the dissection lab learning experience, while providing access to a professor at a geographically distant site, Moorman developed the “Prof-in-a-Box” (PiB) system, and then used basic educational research methods to assess the results.

The PiB system allows students to communicate with an instructor in “real time” via both audio and video, and consists of four components 1) an anatomist with a computer (iMac with Apple OSX, v10.4) and video camera (so that students could see the Prof), 2) “Dr. PiB” = a computer (Mac-Mini) and two video cameras (the iSight FireWire video camera, and an Optura-30 miniDV camera with a longer working distance) in the dissection lab, 3) iChat AV software, and 4) a secure server (again, Apple) to host the anatomy “consultation”. “Dr PiB” was positioned on a lab bench, at the end of the dissection table containing the prosected cadaver. I should explain, for those not familiar with gross anatomy lab dynamics, that the prosection is a cadaver progressively dissected by one or more of the instructors, and usually the students have access to this dissection throughout the course.

The author tracked the number of students at the prosected cadaver and the times they were present, and also logged the questions asked and structures identified. Some of the structures identified were:

Dorsal root ganglion
Dorsal ramus
Common interosseous artery
Obturator nerve
Coronary arteries
Ilioinguinal nerve
Medial pterygoid muscle

Educational research methods included an optional evaluation, as well as comments from the students. In general, most of the students found the PiB system to be helpful, especially in resolving disagreements about dissected structures. Less than a third of the class accessed the prosection during Dr. PiB’s “office hours, but 90-95% of those that did, used the PiB system. The author concludes that the PiB system provides an alternative instruction method for gross anatomy, which may be especially useful for a geographically dispersed faculty.

As a gross anatomy instructor, I can see a few potential problems with the PiB system. First, many students already rely too heavily on the prosection, and are careless or incomplete with the dissections on their own cadavers. This attitude will hurt them on the practical exams, for which most or all of the students’ cadavers are used for tagged structures. I can’t imagine that physicians who supervise the core clerkships in surgery will be well-pleased with students who can only identify structures confidently on a professionally-dissected cadaver. Second, most of the structures listed in the paper are not in the head and neck region, and I wonder whether the camera resolution will allow identification of very small structures in, for example, the pterygopalatine fossa or oral cavity. Finally, although I favor a combination of new technologies and traditional teaching methods in anatomy, I don’t think that anything can replace quality “face time” with dedicated instructors, whether they are faculty, clinicians, or senior medical students. After all, many students choose medicine or dentistry as a career precisely because they enjoy direct interpersonal interaction, and none of the wonderful technological advances in diagnostic, surgical, and therapeutic techniques will change this.

Reference:

Moorman, S.J. (2006). Prof-in-a-Box: using internet-videoconferencing to assist students in the gross anatomy laboratory. BMC Medical Education 6, 55

Moorman, S.J. (2006). . BMC Medical Education, 6(1), 55. DOI: 10.1186/1472-6920-6-55

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