Dissecting and Drawing the Forearm: Anatomical Illustration for the Classroom

ABSTRACT:

Flexor Compartment of Distal Forearm layer 3
Flexor Compartment of Distal Forearm layer 3

The human hand is challenging to study, due to having many narrow vessels and tendons packed together in a small space. Because of this, it is useful to have clear diagrams showing just a few structures at a time. From February to mid-March 2017, a human distal forearm was dissected and used as a model for six drawings in the style of a traditional anatomical atlas. These images are meant to be teaching tools for helping students identify structures, just like a professionally made atlas. During the dissection process, rough pencil sketches were made in the lab as new structures were exposed. Later, these sketches were redrawn in full color with colored pencil. Anatomical illustration could be an educational activity for students: by trying to draw diagrams clear enough for others to understand, students would retain more information and improve their communication skills.

DISSECTION:

In Dr. Olson’s basic gross anatomy course at NIU, the undergraduates often use atlases to help identify countless tiny structures. These atlases introduce students to the art of anatomical illustration, which has roots as far back as the Renaissance. The hand is an ideal subject for an atlas because it has so many tendons, vessels, and bones that can be difficult to keep track of, so it would be helpful to have clear diagrams of these parts. The hand is also more “relatable” relative to internal organs; hands are frequently used for nonverbal communication. People depend on their hands to do so many tasks everyday but rarely think about what goes on behind the scenes.

To separate the forearm from the cadaver, Dr. Olson steadied the body while I sawed (with an actual hand saw) through the radius and ulna distal to the elbow. I used a scalpel to cut a vertical slit in the skin along the anterior side of the arm, from the wrist to the bottom. Then I cut a horizontal line along the wrist and pulled back two flaps of skin to expose the flexors. With a scalpel and forceps, I removed fascia and fat from each muscle and vessel to see the structures more clearly. I made a pencil sketch of the flexors and used the Thieme Atlas of Anatomy 2nd edition to try to identify the structures myself. Then I checked my answers with Dr. Olson. For the next few weeks, I repeated this process of dissecting more structures, sketching the muscles, and labeling the drawings with help from Dr. Olson and TA Sally Jo Detloff. I was generally able to dissect tissues without damaging them, although I accidentally cut the ulnar nerve and had to tie it together with string. Between dissections, I sprayed the arm with humectant and wrapped it in terry cloth to retain moisture.

CREATING THE ATLAS:

Elle_Baker_Foot_Bones
The first drawing was of foot bones.

When I had finished dissecting most of the arm and hand, I had a set of rough draft sketches to turn into final drafts. I redrew each drawing on larger paper and colored the new drawings with colored pencils. To make digital versions of the diagrams, I scanned the drawings and used the GNU Image Manipulation Program to fix margins and erase blemishes. Finally, I presented my work at NIU, at both the Phi Sigma Research Symposium and at the Undergraduate Research and Artistry Day poster shows. I enjoyed teaching the attendees everything I had learned about how the arm works. At URAD, my project won second place out of fourteen exhibits (NIU “URAD and CES Winners Announced.”)

THE DRAWING PROCESS:

Before starting the atlas project, I had never made scientific illustrations and had not taken any illustration courses at NIU. My artistic education was mainly from drawing for fun and taking public school art classes prior to college. Other than confirming the labels with Dr. Olson, I worked on the atlas diagrams independently.

I used photos taken in the lab as references for my color palette, which was meant to be realistic but still simple to understand. Hence, the atlas colors were bolder and more diverse than in the actual arm, where arteries and vessels were the same colors and everything turned more orange over time. The nails were colored to match the cadaver’s nails, which were, in fact, dark magenta. See the final Forearm Atlas diagrams: Flexor Compartment Layers 1-3, Flexors in the Palm, Extensor Compartment Layer 1, and Lateral View: Extensors.

Elle_Baker_Lateral_Extensors
One of the first atlas quality drawings.

 

Other students could benefit from drawing their own diagrams of their dissections. Doing so would help them memorize the names, locations and relationships between structures. While drawing, students might come up with deeper questions about how the body works, like I did during my project. Students could trade drawings and give each other feedback about the clarity of the diagrams. Students would be reminded to focus their critiques on legibility and accuracy rather than on aesthetic appeal. By making their diagrams understandable to others, students would improve at teaching and communicating. Ideally, they would also have fun improving their drawing skills.

Thank you to HAPS for the Student Grant, and thanks to NIU’s Office of Student Engagement for providing me a grant from the Student Engagement Fund. This project was supported by the Body Donation Program at Northern Illinois University, supervised by Dr. Daniel Olson, Director of the Anatomy Laboratory, which ensured the proper and respectful handling and disposal of the tissues used in this project.

Literature Cited

NIU. “URAD and CES Winners Announced.” NIU Today, 26 Apr. 2017, Retrieved from http://www.niutoday.info/2017/04/26/urad-and-ces-winners-announced/.

Office of Student Engagement and Experiential Learning. “URAD Program 2017.” Northern Illinois University, 2017, Retrieved from http://niu.edu/engagedlearning/_pdfs/urad/urad-program-2017.pdf.

Schuenke, Michael, et al. Atlas of Anatomy. Second ed., New York, New York, Thieme Medical Publishers, Inc., 2012.


Eliya Baker graduated from Northern Illinois University with a B.S. in Premed Biology and minors in Psychology and Chemistry. She is not formally trained in art, but enjoys making art as a hobby.  Her teacher and lab instructor is Dr. Daniel R. Olson Ed.D., the Director of the Anatomy Laboratory at NIU. 

Starting on a high note: a first-week-of-fall A&P challenge

I’ll admit it: I’m a bit of an oddball.

To many A&P instructors, music is a tool for learning about the auditory system (Ganesh et al. 2016) or adjusting students’ moods (Anyanwu 2015, Modell et al. 2009, Weinhaus & Massey 2015), or a metaphor for the learning process (Modell 2018).  These are valid, reasonable ideas.  But for me, odd duck that I am, music is mostly a mechanism for teaching science content.  If you can imagine a version of Schoolhouse Rock with really short songs written and performed by amateurs for undergraduate audiences (Crowther et al. 2015), you have the general idea.

There are many reasons why I do this, some well-rooted in research and others less so.  Content-rich lyrics can condense some material into concise, memorable phrases.  Such lyrics can be interrogated to make their meaning clearer, somewhat in the manner of an English class dissecting a poem.  And singing about content with your students is a good way to convey that you care deeply about their mastery of it, and that scientists are human beings too.

STEM Biology Gregory Crowther

If any of these ideas resonate with you, consider the following a friendly challenge for the fall. Are you ready?

  1. Identify and write down the 1-5 most important overall themes that you will emphasize in your course.
  2. Write a short song or rap introducing your students to those themes. If you are not musically inclined — or even if you are — collaborate with a spouse, colleague, previous student, or me to create the best piece that you can. (Here is an example of such a song: http://faculty.washington.edu/crowther/Misc/Songs/blessing.shtml.)
  3. Perform it live for or with your students on the first day of class.
  4. Facilitate a class discussion of what the lyrics mean. (Sample study questions for the song mentioned above are listed toward the bottom of the web page listed above.)
  5. Leave a comment to let me know how this went for you!
  6. Revisit your song at the end of the fall for further reinforcement and reflection.

What about those of you in the “silent majority” who are not quite ready to serenade your students, but are curious about this form of teaching and learning?  Well, consider attending VOICES (https://www.causeweb.org/voices/2018/program) on Sept. 26.  It’s a one-day online conference devoted entirely to teaching STEM subjects via songs.  And it only costs $10!  Is that music to your ears, or what?

 

References

E.G. Anyanwu (2015). Background music in the dissection laboratory: impact on stress associated with the dissection experience. Advances in Physiology Education39(2): 96-101.

G.J. Crowther, K. Davis, L.D. Jenkins, and J.L. Breckler (2015).  Integration of math jingles into physiology courses.  Journal of Mathematics Education8(2): 56-73.

G. Ganesh, V.S. Srinivasan, and S. Krishnamurthi (2016). A model to demonstrate the place theory of hearing. Advances in Physiology Education40(2): 191-193.

H.I. Modell, F.G. DeMiero, and L. Rose (2009).  In pursuit of a holistic learning environment: the impact of music on the medical physiology classroom.  Advances in Physiology Education33(1): 37-45.

H. Modell (2018). Jazz as a model for classroom practice. HAPS Educator22(2): 165-170.

A.J. Weinhaus and J.S Massey (2015).  Pre-lecture reviews with anatomy tunes.  HAPS Educator19(3): 35-38.

 

Dr. Greg Crowther teaches anatomy and physiology at Everett Community College (WA).  His peer-reviewed articles on enhancing learning with content-rich music have collectively been cited over 100 times.

2017_GJC_EvCC

 

Teaching Histology Without a Microscope

This quarter I am teaching a histology unit without a microscopy lab. Wait, histology without microscopes… what!?!? I have never experienced a histology course without a lab component and when I first heard this I was very surprised. How do you teach histology without microscopes? What about the concept of magnification? Isn’t operating a microscope a necessary skill? Then I read a couple of journal articles and considered the merits of a purely virtual histology course.

Everyone loves histology! (Image accessed on 3/18/18 from https://commons.wikimedia.org/wiki/File:Oligoastrocytoma_histology_HE.jpg)
Everyone loves histology! (Image accessed from wikimedia on 3/18/18)

Unless they are involved in a research project requiring optical microscopy or a pathologist analyzing samples, how frequently does the average researcher or medical professional actually use a light microscope? Could time spent practicing optical microscopy be better used learning other skills more relevant to their studies? Maybe career specific workshops or SPSS training? Microscopes are expensive and require upkeep. Could funds instead be used for resources needed in other courses. *cough cough Gross Anatomy cough*

Virtual microscopy is much more efficient for an institution and the students. A college or university could collect a large bank of images that can be updated continuously and won’t deteriorate over time. Online and long distance students are able to fully participate in labs. Slides can be shared rapidly between institutions without risking damaged or lost mail. Instructors can draw on slides to highlight structures without damaging them and students can compare slides of different magnifications or staining techniques side by side.

Histology curriculum often focuses on identifying structures in tissues and relating cell biology to the function of organ systems more than manual lab work. Students could practice reading slides as part of an active learning activity instead. Could microscopy be a workshop or research elective? Training would still be available for students, but only if they are planning to use this skill. This way students genuinely interested in microscopy could receive more individual attention from faculty.

So really, if you consider it, are students losing that much in a histology unit without a microscope? The course I am teaching is “Cell and Tissue Structure and Function.” It is part of the Biochemistry department. Students learn biochemistry and cell biology for the first seven weeks and end with a histology unit from me. We covered the four basic tissue types, integument, circulatory system, cartilage, and bone. The course is part of a physical therapy program. A laboratory component may be important in a course designed for future histologists, but these are physical therapy students. My lectures are packed with images, I have a workshop day set aside to practice analyzing slides, and I think they’ll be okay. 

These are some of the papers I read while thinking about this change:

Mione, S., Valcke, M., & Cornelissen, M. (2013). Evaluation of virtual microscopy in medical histology teaching. Anatomical Sciences Education, 6(5), 307-315.

Mione, S., Valcke, M., & Cornelissen, M. (2016). Remote histology learning from static versus dynamic microscopic images. Anatomical Sciences Education, 9(3), 222-230.

Thompson, A. R., & Lowrie, D. J.,Jr. (2017). An evaluation of outcomes following the replacement of traditional histology laboratories with self-study modules. Anatomical Sciences Education, 10(3), 276-285.


Post comes from Julie Doll, MS, Anatomy Instructor in the Department of Anatomy for Chicago College of Osteopathic Medicine at Midwestern University. 

“I Was Too Embarrassed”

Exploring the Reasons Students Don’t Engage with Instructors to Improve Performance

“I was too embarrassed. He would think I was stupid,” replied my private tutoring client. This was her only response to why she did not meet with her professor after failing every exam the first time she took A&P 2 at a nearby university. I told her that most professors I know don’t assume that you are unintelligent if you’re struggling to understand material. The startling part of this exchange was her response to my reassurance, which was to ask, “Really?” She was genuinely surprised to hear that he would not assume she was an incapable student.

I didn’t think too much about this again until I picked up another student who also failed A&P 2 at a nearby community college. The story was the same, with a few added details. Despite failing 4 exams, no attempt was made to meet with the professor to discuss strategies for improvement. I asked her why. “Probably because I was embarrassed I did so poorly. I didn’t want to face my professor. Also, I didn’t think it would be helpful to go back and look, because reading the correct answers doesn’t really help matters if you don’t understand the content to begin with, so why make myself look stupid?” Now my curiosity was peaked. Is this how most students who don’t want to review and discuss their performance feel? Do they assume that they will either be judged, or that there’s nothing to be learned from seeing their mistakes? This might be especially true when exams are not cumulative. They may assume it’s better to just move on, in which case they are likely to repeat the same mistakes in preparing for the next assessment. It is easy to assume that only the students who are struggling will make appointments to review their performance, but from my experience, t’s usually the students hitting close to the average that view their exams, and the high and low scoring cohorts stay silent. The question then remains: Why would embarrassment stop a student from discussing their performance? Wouldn’t the desire to avoid more failure, or repeating a course, outweigh the risk?

Let’s assume for simplicity’s sake that you have created a supportive environment, you make yourself available, and when students do come, you provide constructive feedback that leaves them more confident and better prepared moving forward. However, the students who are struggling still don’t reach out. What else can, or should, an instructor do, for a student afraid of judgment? It is all too easy to write this off as a “silly” emotion, especially if you are a friendly, enthusiastic instructor (and I’ve never met a HAPSter who wasn’t!). However, after my experiences with the tutoring students over the summer, I decided to change up the language I used when I invited exams this academic year. I stressed the importance of failure in success.  I shared stories of my own academic struggles with students, stressing that some topics came naturally, and others were very hard to grasp, and took many hours of self-study outside the classroom to finally take hold. Finally, and what I feel made the biggest difference, I added the simple statement “please do not feel embarrassed to meet with me and review your exam” to my class email. The result? The number of my A&P students who came to review their midterms this year tripled from the five previous years.

For students, it does not always go without saying that we won’t judge their intelligence or ability. Say it. It takes almost no time, but you may see it make a big difference in the number of students who reach out for help. Do the easy things to get them in the door, and they may leave more self-directed, confident students. It may be hard for those of us who work in education to imagine letting embarrassment prevent us from getting better grades, but I’m sure that if we were all honest with ourselves, we could identify something we avoid because of fear of judgement. Students ultimately have to help themselves, but we can certainly help them get out of their own way.


Dr. Krista Rompolski is an Assistant Teaching Professor at Drexel University. 

Looking for Community College A & P Instructors Who Wish to Engage in Research on Student Attrition

First, a few questions:

  1.  How many of these abbreviations do you know?
  • SoTL
  • DBER
  • IUSE
  • CAPER
  1.  Where do most students in the USA take entry-level anatomy and physiology?

The answer the first question will be at the end, but it’s the second question that is important now.  Answer: Community Colleges!

Community Colleges are where thousands of instructors are teaching tens of thousands of students lessons in anatomy and physiology every day of the academic year.  Students in these courses often have high hopes – they hope to change their lives by gaining the qualifications to enter allied health professions such as nursing, surgical technology, and emergency medicine.  But as most of us know, many students do not complete the two-semester A & P sequence, and others complete the course but do not have high enough grades to continue in the program.  The course needs to be difficult; it’s a difficult topic. But too many students are failing.

I recently gave a SoTL (Science of Teaching and Learning) workshop at a community college that had an attrition rate of well over 50% in A & P.  The instructors in the program all talked about students being academically ill prepared for the rigors of an A & P course.  Other students, they said, were just too busy with work, kids, and “life” to devote the time required to succeed.  “Stress” was a common theme; stress caused by financial problems, family problems, and in many cases academic struggles.  In the workshop we talked about different strategies that “might help” students who struggle.  We can never “save” all our students, but we can improve the present situation.  We can help a few students succeed in A & P who otherwise might fail.

During the next month, a group of HAPS members will develop a National Science Foundation (NSF) ISUE (Improving STEM Undergraduate Education) grant targeting the attrition problem in community colleges.  If funded, we will work with instructors at community colleges who wish to try out a new teaching practice and conduct a small research project on its effectiveness (i.e., Discipline Based Education Research, or “DBER”).  We have to start out small, but if successful we will expand the program to include larger numbers of instructors and community colleges.  (And of course, NSF grants are hard to get – but you’ll never get one if you don’t apply!)

Are you teaching at a community college?  Are you interested in such a project?  If so, read about our project (CAPER) in the text below, which will also be posted on the HAPS List serve later today.    

And now the answer to the first question:

  • SoTL: Science of Teaching and Learning
  • DBER: Discipline Based Education Research
  • IUSE: Improving STEM Undergraduate Education
  • CAPER: College Anatomy and Physiology Education Research

(CAPER is the name of our HAPS/NSF research project!  So a bonus point if you got that one.)

College Anatomy and Physiology Educational Researchers (CAPER) – We want you!

One topic guaranteed to start up chatter on the HAPS Discussion Board is attrition – the disturbingly high number of students failing and withdrawing from our A & P courses, especially at 2- year colleges.  The HAPS Attrition Task Force has spent the past 18 months gathering data to document the problem.  The causes are complex, and the solutions equally so, but as HAPS members we posit that how we teach matters.   Unfortunately, while many of our members teach at 2-year schools, very little data that we use to inform our practices has actually been gathered at these institutions.  We are submitting an NSF grant application to help address this deficiency, and we need participants.  We are looking for 6 to 8 instructors at large enrolment community colleges serving diverse student populations who are willing to act as partners and participants in this grant. We want people who love teaching, love their students, and want to develop methods to help their students succeed – especially those who struggle.

Our goal is to identify specific classroom interventions that will reduce attrition in diverse student populations.  These interventions will target two important components of student success: conceptual understanding of physiology and psychological distress. Educators involved in this project will work together to develop, implement, and evaluate the impact of curriculum and pedagogy designed to influence one or both of these determinants.  We know full well that we cannot “save” all students, but we know that implementing some simple methods into our regular teaching practice can make a big difference our students’ chance of success.

Here is our preliminary plan, but we are interested in working with grant participants to fine-tune the methods.

What Do I Have To Do?

  1. July to December 2018:  Complete a 1-credit HAPS –I course (Title:  Introduction to Educational Research Methods) that covers basic principles of instructional design and assessment, and the mechanics of carrying out classroom research projects. The course includes online sessions as well as an in-person meeting at a regional HAPS conference in the Fall, and your tuition and travel will be covered by the grant.  We know that many of you are also teaching during this period, so will be asking to commit no more than 3 hours per week for this endeavor during the Fall semester. By the end of the course (probably in early December) you will have a plan for an intervention that you would like to try out, and evaluate, in your course.
  2. While completing the course, you will work with one of the course instructors to refine your classroom research project focusing on your specific student population.  Each participant will test the impact of an intervention on student performance (attrition) and stress levels using tools such as validated student surveys, instructor reports, and/or student interviews.  We will provide you with a list of interventions and research tools to choose from, but participants are also welcome to come up with their own.  For instance, one participant might look at how student stress and performance is impacted by two-stage cooperative quizzes, in which students complete a quiz both individually and in groups (cooperative quiz).  Another participant might decide to investigate if his or her students feel less psychological distress, and/or perform better, if they spend 3-5 minutes at the beginning of each group activity discussing their everyday lives. A third might examine the impact of instituting active learning activities, such as those that will be published in an upcoming Special Issue of the HAPS Educator, the inquiry activities on the HAPS website (HAPS Archive of Guided Learning Activities), or the many teaching tips on the HAPS website (A & P Teaching Tips).  We will also help you get Institutional Research Board (IRB) approval for your project. Note that interventions will be realistic and achievable – we are looking for small-scale interventions, not changing an entire course.
  3. January-May 2019: Carry out, analyse, and write up your classroom research project, with the support of the instructional team.  We hope that all participants can present their findings at the 2019 Annual HAPS conference at the end of May, and we also would encourage participants to submit their findings to the HAPS Educator.
  4. We will also ask each participant to participate in informal entry and exit interviews, in which your will discuss your perspectives on teaching and educational research with an interviewer.

Why?  What’s in it for me?

First of all, the educational community needs your input, and data from your students, to inform our practices.  Second, it will be FUN.  Educational scholarship has the potential to revitalize your teaching, and make your job more interesting, challenging, and satisfying.  Third, we will help support your travel to two HAPS meetings (one regional and one national), and there will be a stipend for completion of the manuscript describing your work.   

Sounds Interesting….What’s the Catch?

First, all participants will need to talk to their administrators. They must know what you are doing (research on teaching and student retention), support you in your efforts, help secure IRB / Human Subjects approval for you to conduct your project with students, and work with us to collect data on attrition.

Second, the project will work best if we have teams of two or three anatomy and physiology instructors from one community college, city, or region.  It isn’t an absolute requirement, but apply with a colleague from your own or neighbouring colleges if you can.  It’s even better if your school in involved in a program such as Community College Biology Instructor Network to Support Inquiry into Teaching and Educational Scholarship, or the SEPAL project.  

And third, please remember that this is a grant proposal, and there is no guarantee that the grant will be funded.  We can only accept 6 to 8 participants for the first year, but, if funded, we would run a second group of 6 to 8 participants in the second year.  

Still interested or have questions?  Email the project lead, Murray Jensen, at msjensen@umn.com.  Please include as much of this information as possible:

  • Names of instructor(s):
  • Name of your school:
  • Number of students enrolled in your anatomy and physiology program each year:
  • A rough estimate of your attrition rate (that is, the percentage of your class that receives a D or an F or withdraws before completion:
  • School involvement in national programs:
  • Name and title of your administrator who will support you in this project:

We need to have the list of participants finalized by November 21, so let us know if you are interested ASAP!   

Active Learning: A Practical Approach to Implementation

It’s likely that at this point I do not need to convince most of you that active learning can be highly beneficial to student learning.  There is a multitude of resources, including HAPS Educator articles, which discuss successful active learning in a variety of classroom settings.  But here’s the thing. With so many great ideas at our finger tips, where are we supposed to begin if we want to implement active learning in our own courses?  

GOALS

First, step back from the swarm of ideas swirling in your mind and reflect on your goals. What are the goals of your course (which may or may not be content-related)?  Your goals should shape the type of active learning exercise(s) you implement. Here’s what the participants at my workshop at the HAPS Annual Conference in May had to say about their goals with active learning:

Participants in a HAPS worskhop (May 2017) described their goals for active learning.
Participants in a HAPS worskhop (May 2017) described their goals for active learning.

 

PLAN

To ensure your efforts are manageable, start with just one or two sessions.  Upon successful implementation of the initial activity, you can build off it, or incorporating additional methods.  Allow enough time to develop the activity, implement it in class, and give yourself time afterward to assess and for providing student feedback if necessary.  Some (or all) of these steps can take a lot of time!

BUY-IN

This can be tough.  Students will sometimes resist the unfamiliar (i.e. not a standard lecture).  Be transparent.  Explain the goals of the activity, and if appropriate, share evidence to support the activity.  Ensure students that it is of the appropriate difficulty level for them and that you’re there to guide them.  Considering giving credit for participation, especially if it’s a regular part of class.  For more on this topic, check out the Cavannagh, et al. (2016) article or this blog post from Bryn Lutes at Washington University.

RESOURCES

Classroom Assessment Techniques: A Handbook for College Teachers by Angelo and Cross is a book that will walk you through identifying your goals, selecting appropriate activities for those goals, and it gives you a detailed guide for implementation of the activities and assessment.  Assessment is a critical part of scholarly teaching!  How else will you know if the original goals were accomplished?

Technology.  A simple, yet effective means of incorporating small snippets of active learning into a lecture can be interactive questions.  Similar to “clicker” questions, there are many web-based platforms which enable faculty to easily incorporate interactive questions (multiple formats) into lectures.  It’s an opportunity to give the students practice retrieving informing, as well as allowing instructors to see where students are in their understanding of the material.

Some audience response systems allow students to touch the correct answer on an image, and the data for the whole class shows up as a heat map!
Some audience response systems allow students to touch the correct answer on an image, and the data for the whole class shows up as a heat map!

Low-tech options.  In lieu of all of the apps and high-tech options out there we sometimes forget that a marker board, or pen and paper can be effective tools.  Drawing or writing out a process in a way that is meaningful to students (and maybe incorporating a drawing) is an effective means to promote learning.  Get creative with other materials too!  Pull ‘n’ Peel Twizzlers make a great model of vascular supply, and playdoh, pipe cleaners, paper, etc. can be used to model many different body parts.

While this is by no means an exhaustive list of resources available for us to use in teaching, I hope it helps you get started.  Establish your goals.  Pick an activity to meet those goals. Plan well, and don’t forget to include assessment!  Happy teaching!


Cavanagh, A.J.,  Aragón, O.R., Chen, X., Couch, B.A., Durham, M.F., Bobrownicki, A., Hanauer, D.I., & Graham, M.J. (2016). Student buy-in to active learning in a college science course. CBE Life Sci Educ 15(4).

Michael, J. (2006). Where’s the evidence that active learning works? Adv Physiol Educ 30: 159-167.

Pierce, R., J. Fox. (2012). Vodcasts and active-learning exercises in a “flipped classroom” model of a renal pharmacotherapy module.  American Journal of Pharmaceutical Education 76(10): 1-5.


Audra Schaefer is an Assistant Professor of Anatomy and Cell Biology who teaches neuroanatomy and histology to first year medical students.  She oversee multiple systems-based integrated courses that are part of the first two years in the medical curriculum.  She also conducts educational research, with interests in metacognition, study skills and remediation.

Getting Them out of Their Funk

Muscles and bones, bones and muscles. How many times have my students learned the deltoid tuberosity in the bone unit, only to complain that they have to learn all these bone names as part of their muscle attachments?! Many of my students come in thinking they are going to simply learn the names of the bones, having little understanding that there is a whole world of terms for bone landmarks. To help my novice students become proficient, I have made two changes.

muscle-attachmentsHistorically, my labs followed a 2 week period of appendicular and then axial bones, followed by a 2 week period of appendicular and then axial muscles. My students scraped an average of around 67% on their weekly practical quizzes. They always did slightly better with their bones, and then much worse with their muscles in part due to that muscle attachment component. I wanted more, so I flipped to appendicular bones one week, followed by appendicular muscles the next week. Their averages went up to 78% for the unit, but I still got a little of the whining related to bone landmarks. Their scores were higher on bone weeks and lower on muscle weeks, so I switched to regional study of the body, bones and muscles of the leg one week, the arm the next and so forth.  For the last three years, my averages for this unit have settled around 75%, but the students are making the connections between bone landmarks and their muscle attachments.

muscle-to-attachmentI remember when I took A&P, my lab instructor handed me a Rubbermaid with the bones for that week and said, “Get to it!” I had the “luxury” of having previously taken  Comparative Anatomy class, so 5 of my peers worked with me to learn the material. Most of my peers left lab and were overwhelmed. So when I started teaching A&P, I tried to help the students whose strategies mimicked my classmates’, but I kept running into an almost total mental shut down the moment I handed out their term list for the week. So I made a second change. Now my labs have 6 stations and students spend about 15-20 minutes at each station. Each station has an objective, which also helps the students chunk up the material into manageable pieces.

skeletonJust what can you do at these stations? One is the dissection/prosection table with the cadaver or cat. One is a pile of bones and they have to put Humpty Dumpty back together again – recognizing left vs right and what the bone names are. Another station has a plastic skeleton with felt muscles and scotch tape to study origin, insertion, action. I have brought in Halloween skeleton decorations and asked the students to look for anatomical inconsistencies. Another table has a few bones with the goal of identifying the landmarks from their list of terms.

You may be thinking that this doesn’t get to every student, but I have noticed is I now have students who either pass their lab quiz well, or they really, really don’t pass. There aren’t so many in the middle. It tells me the students who are studying, vs not spending the time studying and I have fewer students who are all out “tanking with pride,” as I call it. It seems to be working. A student came to me yesterday and told me that she had attempted to take A&P at another institution, but she got so lost in all the material, she didn’t know where to start. She felt my lab set up helped her divide and conquer the content into manageable pieces.

It’s easy to become complacent with our students, and forget that sometimes our students need ideas presented in a way that helps them begin to categorize and learn the material. What is so simple to us may be the straw that breaks the proverbial camel’s back for them.  It’s a lot of work to help our students figure out where to start and learn how to be a learner, but so rewarding when it works.


Nichole Warwick teaches biology at Clatsop Community College and is a proud member of the HAPS Communications Committee.