In Search of the Core Principles of Human Anatomy: RESPONSE

Bradley Barger
A message from Bradley Barger, graduate student researching anatomy education.

HAPSters spend a lot of time discussing the teaching and learning of anatomy and physiology.  Last week we had a post from Central Regional Director, Murray Jensen challenging the long lists of required structures in anatomy classes. Bradley Barger, graduate student researching anatomy education, responds.

This post contains two main points-

  1. Anatomy contains physics, sort of. The way anatomy is taught can emphasize this, or ignore this, each approach having some benefit.
  2. The “hot list” of anatomy terms is a bigger challenge than can be answered here, but before including any term on your “hot list” see if it meets at least one (ideally several) of the core principles defined here. Those anatomical structures that align with the core principles can be used as case studies to illustrate the underlying rules of anatomy, even if the deepest level of those rules (physics, chemistry and physiology) are not explicitly taught to students.

The shapes, orientations, and interactions of anatomical structures are all based on physiology. Every structure identified in anatomy exists because of the physiological adaptations of the organism, so understanding the anatomy requires an understanding of the physiology, histology, cell biology and biochemistry, all fields with strong bases in physics. So anatomy may contain physics, it has just been buried under several layers of abstraction (or application).

Anatomy could be taught from a “bottom-up” approach where all the background knowledge of physics, chemistry, and physiology (the “rules” of anatomy) are learned first. In this approach, the anatomy of the organism is just the most visible part that solves all of the physical and physiological problems involved in maintaining life. Anatomy becomes a foregone conclusion once the rules of life have been established. However, anatomy is usually taught from a “top-down” approach. In this approach the anatomy of an organism is learned first, because it easy to see, touch and understand. Oftentimes this approach results in a memorization paradigm, because the “rules of anatomy” (i.e. chemistry, physics, and physiology) have been left out. Without understanding the rules, the anatomy of the organism seems like a needlessly complex series of tubes with arcane names, leaving many students baffled.

Because no anatomy course, or even an entire college career, has the time to teach anatomy from a true “bottom-up” approach, we have developed a series of core principles of anatomy that provide insights into the rules of anatomy, without the need for extensive instruction in physics or physiology. These core principles are designed to emphasize a deeper understanding of anatomy, and avoid the memorization problem that has plagued so many students (and instructors) in anatomy courses.

(Please note, this list is a first attempt at defining core principles of anatomy and was developed largely by myself at the 2014 HAPS annual conference in Jacksonville. I have since been in conversation with many other anatomy instructors and students in an effort to further develop this list, and have gotten some great feedback and recommendations, but we can leave that conversation until San Antonio.)

The core principles-

  1. Orientation– This is perhaps the most basic skill in anatomy and involves knowing which end is up. This skill also includes the relationships of nearby structures, and how they may interact.
  2. Spaces, solids, and coverings (linings)– In anatomy identifying three-dimensional (3D) solids is a relatively easy task. Finding the liver, hypothalamus, or biceps brachii are all easy tasks because they are solid objects that can be seen and touched. But often overlooked are the conceptually more challenging anatomical entities which exist as empty space, or as essentially two-dimensional linings of other structures. Students often struggle to understand the relationships between serous membranes and their cavities and associated organs, for example.
  3. Nomenclature– It has been said that learning anatomy is like learning a language, and the vocabulary is one of the more challenging aspects of this task. Nomenclature is included as one of the core principles because the names of structures are not arbitrary, even though it can feel that way to a novice student. If the names and meanings of words can be taught more explicitly, many of the problems in point 1 (orientation) become much easier to manage.
  4. Macro and microscopic relationships– This principle deals with the rules of anatomy more explicitly than the others, and is a great way to emphasize physiological concepts even in a pure anatomy class that may not otherwise include physiology.
  5. Visual Literacy– This principle deals with the ability to gain information from visual sources. Visual sources can include two-dimensional (2D) drawings, 3D models, or even anatomical remains. Many students do not know how to ‘read’ an image, and even advanced students struggle with converting their knowledge of 2D book images to 3D models or cadavers.

In response to the question about the foramen spinosum, I would argue that it is a good structure to include on the ‘hot list’. Teaching the foramen spinosum offers an opportunity to discuss many of the above principles, and relate those ideas to the rules of anatomy. First, the foramen spinosum is a space, and can serve as a valuable example of anatomical spaces, and their functions. As the foramen spinosum conducts the middle meningeal artery into the skull, it can also be used to teach principles of orientation and illustrate the fact that the skull is not a sealed chamber, but contains many passages for arteries veins and nerves, all based on the physiological needs of the organism. Related to orientation, students can see the groove for the middle meningeal artery leading directly to foramen spinosum, illustrating the interaction between the blood supply and the bones. The foramen spinosum can also be used as an example of nomenclature as its name directly relates to the appearance of the hole. Finally, learning any of the skull foramina teaches about visual literacy in that 2D book images can portray this hole in a variety of ways, and these images will look different to a real or model skull.

A similar argument could be made for nearly any structure chosen, so how does this help us to define the ‘hot list’ of structures that a student should know? Maybe it doesn’t, but it at least allows for each structure taught in anatomy to serve more than one purpose, and hopefully help students to get away from the idea that “anatomy is all memorization.”

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