APRIL 2010: Perspectives from the Class of 2013

The New Anatomy: Impressions of a First-Year Medical Student

When I tell strangers I am a first-year medical student at Columbia P&S, one of the most common questions is, “Have you been assigned a body yet?” In fact, my class was introduced to our “bodies” in early September and, yes, I confess I felt extremely queasy on the first day of gross anatomy.

This year, with the advent of the new curriculum, the anatomy course has undergone major revisions. What was formerly a 200-hour commitment for first-year medical students, running from September through March, has been abbreviated to 130 hours, with the last test administered in late December. The task of restructuring gross anatomy was assigned to a new professor, Dr. Paulette Bernd, who received her doctorate in anatomy from Columbia University. Before joining P&S, Dr. Bernd worked at SUNY Downstate for 21 years and ran the anatomy course there for 19 years.

Before Dr. Bernd’s arrival, Dr. Ernie April directed the anatomy course for 40 years. He is vividly remembered for providing a steady stream of information for 60 minutes during a slide show. The course was notorious for its difficulty and for Dr. April’s entertaining delivery. We have heard a rumor that two to three students per year typically did not pass and were required to attend “anatomy camp,” a summer course in Vermont, not a welcome prospect for a first-year student.

It was Dr. Bernd’s task to decrease anatomy class hours by 35 percent while still teaching a sufficient body of material. This was accomplished by modifying the course in several significant ways to permit more efficient use of time with a slightly altered overall focus. Dr. Bernd presented approximately 60 percent of the lectures with other anatomy faculty delivering the remainder of the material. All lectures included PowerPoint slides with detailed information accompanying relevant images. The textbook for the course was Moore’s “Essential Clinical Anatomy,” and we typically were required to read 40 to 60 pages per week. The text offered complete explanations as opposed to the previous book, which was written in outline form.

Another innovation follows the hour lecture: Half of the students proceed to dissecting session while the other half remains for a one-hour clinical correlation lecture (such as discussion of orthopedic upper extremity injuries or cardiovascular surgeries relating to the anatomy topic taught that week). Students assigned to the second lecture proceed to the 17th floor of the Presbyterian Building to work in groups on “anatomy cases.” This consists of reading and solving a case, analyzing radiographs, viewing models of bones to identify certain structures, and group analysis of the specific body parts affected by the injuries described.

The implementation of “non-dissecting” sessions involving a “bone box” provided students with additional practice examining radiographs with an atlas to identify joints, arteries, nerves, etc. in the slides. Surface anatomy also was given increased prominence in the learning experience. These methods of case-based learning exposed us to the material in a visual manner, further cementing the knowledge gleaned from the text and actual dissection.

The changes were popular with students. Most of us feel we mastered anatomy by reading the textbook, viewing the slides, and meeting with our groups on the weekends to identify the structures in the dissected bodies. Time spent dissecting was less than in previous years, but Dr. Bernd says she will never completely omit dissection, as has been done at other institutions, because it is a learning experience promoting crucial analytical skills.

Of course, we didn’t escape the proverbial tests. Three multiple choice tests consisting of 40 to 50 questions each were used for assessment purposes. In addition, we took practical exams the same day the written tests were administered. A major change involved the implementation of a “group” practical exam. Previous practical exams had been stressful for students because they had a limited time (about 1.5 minutes) to identify tagged structures, even malformed body parts or obtuse structures. Dr. Bernd conducted practical exams with groups of four, with the group convening to reach an answer and receiving just one grade for the group. Group practical and individual written exams were given equal weight to determine our final pass or fail grades.

Dr. Bernd had not originally planned to structure the practical exam in a group format, but the logistics of having 220 students rotate individually to 35 stations (it would have taken all day) and student feedback led to the group testing format.

Approximately once a month, 10 medical and dental students met with Dr. Bernd and administrators to offer their opinions on the course. At the dean’s advisory lunch, students reported stress caused by three hours of morning lecture followed by afternoon anatomy or clerkship, leaving students only two free afternoons per week. We felt overwhelmed with the amount of material we were required to learn in the new condensed time frame. The group practical test was devised to address this problem. No other medical school has instituted a team anatomy practical exam, but the dynamics of group testing motivated us. If we slacked in our anatomy preparation, we let down the entire group. The testing and condensed coursework was still stressful, but our anxiety was reduced to some degree.

Improvements for next year’s course include more lectures by Dr. Bernd, an increased number of physicians in the lab to assist students, and bone box sessions conducted on days students do not dissect so that Dr. Bernd is present to instruct and answer questions.

Dr. Bernd

At the conclusion of the course, we presented Dr. Bernd with a token of our appreciation – custom dissecting shears. Choosing the shears was an interesting exercise. The idea originated with our classmate, Anthony Anagnostou. To maintain the element of surprise, Anthony emailed Dr. Bernd on the pretext that he wanted to purchase shears for himself and needed advice. He repeatedly emailed her with questions concerning the best material and model. She was confused about why Anthony was so persistent with his “scissors” question, but she answered every one of his emails. On Jan. 4, 2010, we surprised her with presentation of titanium shears with gold handles and engraved with her name. She plans to have the custom shears framed to hang in her office.

Please let me know (psjournal@columbia.edu) what topics interest you from a first-year student’s perspective.

Jennifer Lee Perri graduated Phi Beta Kappa from Princeton University in 2009. She was the Grand Prize winner of the 2009 Princeton Undergraduate Research Symposium and recipient of the 2009 Charles M. Cannon Memorial Prize for best senior thesis presentation in the Ecology and Evolutionary Biology Department.