1. Active Learning Exercises in the Anatomy Lab to Review Radiologic Anatomy
Ann Zumwalt, Ph.D., Department of Anatomy & Neurobiology
Rebecca Lufler, Ph.D., Department of Anatomy & Neurobiology
Kitt Shaffer MD PhD, Department of Radiology

2. Outline Context of our project Traditional medical school curriculum
Objectives of the project
Radiological Anatomy lab
Design
Examples
Discussion
Insights from our experience
Applicability of our approach to a broader context

3. Year 1 Context Med School Curriculum Gross Anatomy Biochemistry
Physiology
Histology
Other courses dealing with applied clinical skills

4. Year 1 Year 2 Context Med School Curriculum Gross Anatomy Biochemistry
Physiology
Histology
Other courses dealing with applied clinical skills
Year 2
Microbiology
Pathology
Pharmacology
Health Law
Other courses dealing with applied clinical skills

5. Context Med School Curriculum Clinical years
Assorted required clerkships (Pediatrics, Obstetrics & Gynecology, Psychiatry, Family Medicine, Surgery, Medicine, Neurology, Radiology, Geriatrics)
Electives to explore these or other fields more intensely.

6. Context - Summary
Anatomy is traditionally taught near the beginning of medical school
Studies have shown that students demonstrate relatively poor retention of this material, despite its relevance to their subsequent clinical education and work.
In this project, we established a new educational session during the radiology clerkship that revisits anatomy knowledge and principles that are relevant to that clerkship.
Incorporating radiology into first year anatomy courses is not uncommon.

7. Radiology Clerkship Context Logistics:
Required clerkship for all medical students (3rd & 4th years)
Four weeks long
Approximately 20 students per block
Radiology Clerkship
“…The course is comprised of didactic lectures, departmental conferences, small group sessions on evidence-based imaging, case review sessions, and clinical observations in general radiology, pediatric imaging, musculoskeletal imaging, neuroradiology, abdominal and pelvic imaging, thoracic imaging, breast imaging, nuclear imaging, and neuroradiology.”
-Clerkship overview, BUSM Radiology dept

8. Radiology Clerkship Objectives The objectives of this project were to:
Reinforce anatomical concepts the students learned in their first year

9. Radiology Clerkship Objectives The objectives of this project were to:
Reinforce anatomical concepts the students learned in their first year
Demonstrate the clinical applicability of this knowledge

10. Radiology Clerkship Objectives The objectives of this project were to:
Reinforce anatomical concepts the students learned in their first year
Demonstrate the clinical applicability of this knowledge
Demonstrate the anatomical basis for difficult concepts in radiology, e.g:
3D anatomical relationships when viewed in 2D
Rationale for interventional radiology procedures

11. Radiological Anatomy Lab
Design
Radiological Anatomy Lab
All students in the clerkship assemble in the anatomy lab for two hours.
Four work stations
Each group spends ~20 minutes at a station, completes the exercises and answers questions then rotates to the next station.
Class reconvenes at the end to discuss the lessons of the four stations
Required clerkship; 4(?) weeks in 3rd or 4th year
Radiology = anatomy
More challenging b/c the entire body is eligible
Also produces more opportunities

12. Design
Layout of Room
Station 1
Station 2
Station 4
Station 3

13. Design
Layout of Room
Station 1
Basic anatomy
Radiological images of relevant anatomy
Station 2
Model building
Clinical procedure
Practice with clinical instruments, if applicable
Station 4
Ultrasound (US) station
Radiology residents teach the students how to use the US and how to interpret images
Station 3
Model building
Computer station
Radiological images / movies relevant to the procedure

14. Station 1 – Shoulder & Hip Musculoskeletal Imaging
Examples

15. Station 1 – Shoulder & Hip Musculoskeletal Imaging
Examples

16. Stations 2 & 3 - Femoral Triangle & Subclavian Region
Examples

17. Stations 2 & 3 - Femoral Triangle & Subclavian Region
Examples
How would you locate the femoral vein to place a femoral line?
If you are attempting a femoral artery access for angiography and go too far lateral, what structure is at risk?
Where it the most restricted region for a subclavian catheter, where it is most likely to be pinched by skeletal structures?
After completing Stations 2 and 3, please answer the following question:
Why is the femoral artery preferable to the axillary artery or carotid artery for vascular access to the aorta for angiography?
Example questions from worksheet:

18. Station 4 – Ultrasound Imaging of Neck and Upper Extremity
Examples

19. Station 4 – Ultrasound Imaging of Neck and Upper Extremity
Examples

20. Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Examples
Interventional radiologists use image guidance to make a tunnel through the liver to connect the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (three veins that carry blood away from the liver back to the heart).
Maleux, G. et al. Am. J. Roentgenol. 2007;188:

21. Station 1 – Gross Anatomy of Portal System (vascular drainage to liver)
Examples

22. Station 2 – Practice TIPS Procedure & Seldinger Technique
Examples
Seldinger technique tools

23. Station 3 – Imaging of TIPS procedure
Examples

24. Station 4 – Ultrasound Imaging of Neck and Upper Extremity
Examples

25. Feedback Discussion Suggestions for improvement
“Allowing more time and adding spine anatomy could be helpful for visualizing posterior elements (oblique vs. lateral c-spine views).”
[timing, materials, topics]
“Maybe some landmarks for subclavian lines?”
We seem to be meeting our objectives
“Musculoskeletal anatomy is very confusing on radiograph, so this station was excellent.”
“Really enjoyed the session. Great to have some 3D models to learn from and connect to the 2D images. As a 4th year, I very much needed the reminder when it came to the anatomy!”
Allowing more time and adding spine anatomy could be helpful for visualizing posterior elements (oblique vs. lateral c-spine views). [timing, materials, topics]
Musculoskeletal anatomy is very confusing on radiograph, so this station was excellent.
Maybe some landmarks for subclavian lines?
Really enjoyed the session. Great to have some 3D models to learn from and connect to the 2D images. As a 4th year, I very much needed the reminder when it came to the anatomy!
Man, it felt like going back to high school/college again - a good, conductive, interactive learning environment. First time I can say I've had a learning experience like this in medical school (which is indeed VERY SAD). Props to the radiology department. :)
“Man, it felt like going back to high school/college again - a good, conductive, interactive learning environment. First time I can say I've had a learning experience like this in medical school (which is indeed VERY SAD).”

26. Analysis, Insights, Future directions
Discussion
Analysis, Insights, Future directions
Principles of Adult Learning and recommended teaching practices
Adults often have a problem centered approach to learning
Show immediately how new knowledge or skills can be applied to current problems or situations; use participatory techniques such as case studies and problem-solving groups

27. Analysis, Insights, Future directions
Discussion
Analysis, Insights, Future directions
Principles of Adult Learning and recommended teaching practices
Adults often have a problem centered approach to learning
Show immediately how new knowledge or skills can be applied to current problems or situations; use participatory techniques such as case studies and problem-solving groups
Adults have years of experience and a wealth of knowledge
Use open-ended questions to draw out students' knowledge and experiences; provide many opportunities for dialogue among students

28. Analysis, Insights, Future directions
Discussion
Analysis, Insights, Future directions
Principles of Adult Learning and recommended teaching practices
Adults often have a problem centered approach to learning
Show immediately how new knowledge or skills can be applied to current problems or situations; use participatory techniques such as case studies and problem-solving groups
Adults have years of experience and a wealth of knowledge
Use open-ended questions to draw out students' knowledge and experiences; provide many opportunities for dialogue among students
Adults need to feel self-directed
Expect students to want more than one medium for learning and to want control over the learning pace and start/stop times

29. Analysis, Insights, Future directions
Discussion
Analysis, Insights, Future directions
Principles of Adult Learning and recommended teaching practices
Adults often have a problem centered approach to learning
Show immediately how new knowledge or skills can be applied to current problems or situations; use participatory techniques such as case studies and problem-solving groups
Adults have years of experience and a wealth of knowledge
Use open-ended questions to draw out students' knowledge and experiences; provide many opportunities for dialogue among students
Adults need to feel self-directed
Expect students to want more than one medium for learning and to want control over the learning pace and start/stop times
Adults tend to be less interested in survey types of courses and more interested in straightforward how-to
Focus on theories and concepts within the context of their applications to relevant problems; orient the course content toward direct applications rather than toward theory

30. Analysis, Insights, Future directions
Discussion
Analysis, Insights, Future directions
Principles of Adult Learning and recommended teaching practices
Adults often have a problem centered approach to learning
Show immediately how new knowledge or skills can be applied to current problems or situations; use participatory techniques such as case studies and problem-solving groups
Adults have years of experience and a wealth of knowledge
Use open-ended questions to draw out students' knowledge and experiences; provide many opportunities for dialogue among students
Adults need to feel self-directed
Expect students to want more than one medium for learning and to want control over the learning pace and start/stop times
Adults tend to be less interested in survey types of courses and more interested in straightforward how-to
Focus on theories and concepts within the context of their applications to relevant problems; orient the course content toward direct applications rather than toward theory
Adults have increased variation in learning styles (individual differences among people increase with age)
Use a variety of teaching materials and methods to take into account differences in style, time, types, and pace of learning

31. Analysis, Insights, Future directions
Discussion
Analysis, Insights, Future directions
Strengths
Weaknesses
Pedagogy / Andragogy
Students are only able
to participate one time (one topic, no longitudinal reinforcement)
Active learning
Review / “springboard” of knowledge
More efficient focus on the clinically relevant points
Difficult to test outcomes
Collaboration / cross-talk between students; between fields (anatomy & radiology)
Logistics
Flexibility with time, scheduling, staffing
Future Directions
More topics
Incorporate cadaver station
Assess effectiveness
Inexpensive materials

32. Translation to other fields…
Discussion
Translation to other fields…