Gross Anatomy Laboratory Policy & Procedures

The use of human cadaveric material for medical education and research is a privilege, not a right. The bodies available for dissection here at Tufts University, were donated by individuals who cared so much about education and research that they have made this very important decision. The following policies and procedures are based on PATIENT PRIVACY, SECURITY, SAFETY, and MAINTENANCE so that both student and faculty alike maintain the highest standards of DIGNITY & RESPECT that our donors and their families so rightly deserve.

PATIENT PRIVACY: 

The right of privacy and confidentiality due all medical patients is extended to our anatomical donors at all times. This donor should be considered your first patient!

• Use of cameras, cell phones, or other photographic or video equipment, are not permitted in the laboratory at any time, by anyone. Requests for photography of anatomical specimen for educational purpose must be submitted to either the AGP Program Director or Course Director, and reported to the AGP Program Director for final approval and scheduling.
• In consideration of the family members of those who have donated to Tufts, refrain from conversations regarding anatomical material outside the lab.
• No anatomical specimen or cadaveric material shall be removed from the laboratory for any reason.
• Only students, course faculty, and other authorized Tufts University personnel are allowed access in the gross anatomy labs. Permission to bring a visitor to the lab must be requested through the AGP, program director or a course director, and will be restricted to healthcare professionals or individuals with an approved academic purpose. Any Course Director approved permissions must be reported to the AGP Program Director for final approval, verification and scheduling.
• Cadavers should be appropriately covered at all times. Those regions not being studied during the session should be shielded from view by the body bag, to be completely covered prior to leaving the lab. 

SECURITY:

• All access to the lab is via electronic ID card key, and granted on an “at need basis”. No exceptions or visitor will be permitted without the consent of the program or course director. All admittance will be recorded in the University ID card database.
• The Main Gross Anatomy Lab will maintain the same hours of operation as the Hirsh Health Sciences Library, located on the Boston Campus.
• Laboratory doors are to remain closed at all times.
• All books, dissection tools, and body positioners are to be kept inside or on top of each station. Any lost or “borrowed” items will be the responsibility of those assigned to the station.

SAFTEY: 

• Gloves: Are required while dissecting in the laboratory. Ripped gloves must be replaced immediately. Used/torn gloves are to be discarded in an appropriate trash receptacle.
• Clothing: Shorts and short skirts are not allowed in the lab. Scrubs are recommended but not required. Footwear should consist of closed-toe shoes (i.e., no flip-flops or sandals). Long hair should be pulled back for protection. 
• Dissection/Surgical Instruments: Great care should be taken when using any of the instruments in the gross anatomy lab. When instruments are not in use, they should be placed back in the instrument tray. At the end of class/session, all instruments should be cleaned and placed back in their proper storage compartment. DO NOT LEAVE LOOSE INSTRUMENTS IN BODY BAG! 
• Scalpels: Dull blades can be more dangerous than sharp ones and should be changed regularly, and disposed of in sharps containers located in various stations along the perimeter of the lab. Take extra care when two or more members of the dissection team are cutting in the same area. 
• Contact lenses are NOT allowed in the lab. Fixative vapors trapped beneath the lenses can lead to permanent damage to your eye. 
• Spills: a spill of embalming fluid or fatty tissue can make the floor slippery. If any fluid or tissue should spill on the floor, WIPE IT UP immediately with a paper towel and soapy water. 
• Accidents/Injuries: Any scratches or cuts must be treated immediately by the person sustaining them. If any accident does occur please notify faculty immediately. All scratches, abrasions and open skin must be covered completely when in the laboratory. If something gets in your eyes use eyewash station and report to faculty. 
• Chemical/Spray bottles: Each station has been supplied with three spray bottles: Wetting agent (pink), Mold retardant (blue), and Disinfectant (white). MSDS sheets can be found on each of the tables around the perimeter of the lab, as well as a detailed description of individual use/purpose. Please let the program director know if any need to be replenished. 
• Pregnancy: Faculty or students who are pregnant, or believe they may be pregnant, are responsible for discussing attendance in the gross anatomy labs with their physician. 
• Food/Drink: At no time shall food or drink of any kind be allowed in the labs.

MAINTENANCE:  

Part of being respectful is to be as clean and neat as possible. Therefore, anyone utilizing the space, for any purpose, must take an active role in maintaining it.

• Students are responsible for the overall cleanliness of their assigned stations.
• Cadaver tissue should be placed in tissue buckets matching their table number. Replacement liners can be found on the tables around the perimeter of the laboratory. AT NO TIME SHOULD TISSUE BUCKETS BE USED FOR ANYTHING OTHER THAN HUMAN TISSUE, i.e. common trash.
• Paper towels and gloves should be thrown into trash receptacles. 
• At the end of the session, the table and instruments shall be cleaned and wiped down using disinfectant supplied at each station. All related course materials/instruments/tissue buckets, etc… shall then be placed on top of or inside your assigned station. Anything left on the floor or anywhere else (including other tables) in the lab will result in loss of use of the item all together, meaning the University will not supply another!

*All requests to use the lab for purposes outside the realm of coursework must be submitted to the AGP program director for review and approval 

Anatomical Gift Program Director, Brian C. McKinney           brian.mckinney@tufts.edu

Anatomical Gift Program Coordinator, Sharon Belding           Sharon.belding@tufts.edu

Memorial Service: On Sunday, May 3th, 2015, we will hold a memorial service in honor of the body donors. The families of the donors will be invited. This is a very moving event and the families want to speak to the students who worked on their loved ones. The Medical School, Dental School and the Physicians Assistant classes will all participate in this service. The Clinical Anatomy class really does not end with the final exam, but rather with the Memorial Service where we honor your First Patient and provide closure to the families.

GRADING POLICY

MEDICAL CLINICAL ANATOMY

The course is graded by the Pass/Fail system. Methods of evaluation consist of 3 laboratory practical examinations and 3 oral quizzes to be administered in the lab shortly prior to the major exams and three written MedFoundations II examinations which will include questions from the Clinical Anatomy section of this unit.

The purpose of the oral quizzes is 3-fold:

• to assist students in reviewing for the exams
• to ensure that dissection is complete and that each table is maintained in meticulous condition
• to afford each lab group one-on-one contact with an instructor

The laboratory examinations are comprehensive, including structure identification and theory questions designed to test the material taught in lecture. It includes questions on osteology, embryology, and clinical correlation

The laboratory practical examination requires explanation to those students unfamiliar with this type of test. In order to be sure that everyone understands the mechanics of the lab exam, a “practice practical” will be administered shortly before the first (Lower Limb) exam. The results of this test will not be recorded but will serve as an indicator to each student as to how well he or she is mastering the material.

Oral quizzes are based on a 15-point scale; they are awarded to the dissection group as a whole. They are intended to evaluate:

• quality and completeness of dissection
• general knowledge and understanding of the dissection, related osteology and lecture material
• neatness and cleanliness of the dissection table and surrounding area
• teamwork and professionalism in group interaction

The MedFoundations II written examinations will include questions from Clinical Anatomy as well as from Physiology, General Pathology and Pharmacology as well as integrated questions from these areas.

The final course grade will be based on the results of these exams and quizzes:

Lower Limb/Back Lab Quiz                             5%

Lower Limb/Back Lab Practical                      15%

Lower Limb/Back Written Exam                     10%

Upper Limb/Thorax Lab Quiz                          5%

Upper Limb/Thorax Lab Practical                   20%

Medgoundations II Written Exam  III           10%

Abdomen/Pelvis Lab Quiz                              5%

Abdomen/Pelvis Lab Practical                         20%

MedFoundations II Written Exam IV            10%

 CADAVER AUTOPSY REPORT

Introduction  

The primary teaching and learning tool in our Clinical Anatomy course is dissection of your cadaver. You should remember that the cadaver you dissect was once a living human being, and a real patient at some point in time. Therefore, to show the proper respect for this person who donated his or her body to Tufts, you should consider this person as your first patient.

The cause of death of this person is given on the death certificate and can be found, along with the first name and age of the person, on a list posted in the gross lab. The cause of death listed on the death certificate is often listed as the immediate cause of death. However, the immediate cause of death may have been preceded by some other long-term disease process(es). As you dissect the cadaver, you may discover pathology or variations from normal anatomy that may or may not have contributed to the death of the individual.

As part of this course we ask you to compose a Pathology report for your cadaver. This report will not be graded, but it is required and should be turned in to the Course Dorector before the final lab practical exam. A benefit of this exercise is integration of coursework within our MedFoundations curriculum. In addition, this exercise will assist you in developing an understanding about normal and pathological structure and function of the human body as presented in, for example, the Physiology and Pathology courses of MedFoundations II.

As you perform your dissections, you should take notes regarding abnormal or pathological conditions. At the end of the course, each table will compose a written CadaverPathology Report that summarizes your findings (and interpretations) from the cadaver. In addition, you will provide a suspected cause of death (based on your observations) for your cadaver in your written report. You should be diligent and record your notes after every lab. This activity cannot be done accurately in a single day at, or near the end of the course because much of the pathology you notice early on will be removed and/or destroyed by subsequent dissection.

Instructions for the Cadaver Pathology Report 

The report should be typed and contain no more than two pages of text. It should include your table number and immediate cause of death as listed on the sheet in the anatomy lab. You should describe the appearance of the region or organ system you are writing about and how that appearance was different from normal anatomy. You should also describe the overall condition of the body, including observations of surface anatomy and whether there are any prostheses (e.g. pacemakers, artificial heart valves or joint replacements). If there are major variations in branching of blood vessels or nerve structures, describe these as well. (If the region or organ or organ system has no abnormality, describe the normal anatomy for that region or organ system.) Your description should include where the pathology is located, the type of pathology, its size, shape and weight and whether there are multiple abnormalities involving several organ systems (e.g. due to metastic tumors).

PEER ASSESMENT

One of the most important objectives of this course, and, indeed, as a medical student and future physician, is to develop professional relationships with faculty and fellow students in the spirit of mutual co-operation and life-long learning. In order to promote this objective, we have added a new Peer Assesment component to the course in which students will have the opportunity to evaluate their lab partners’ work during lab sessions. It is specifically designed to provide incentive and encouragement for all students to be respectful, helpful, clean,and team players, in the lab. This idea of peer assessment came out of some of “strategies for learning” meetings several Anatomy faculty attended over the past year while also being promoted by the Office of Educational Affairs (OEA) and the Licensing Committee on Medical Education (LCME).

Peer Assesment, is mandatory and will be implemented in this way: Following the lab practical exams on the Lower Limb and Back, Abdomen and Pelvis, and Head and Neck, students will go on-line (TUSK) and fill out a form which evaluates various criteria pertaining to each of their four or five lab partners during that unit of the course. Specific types of behavior to be evaluated include the following:

Evaluation by each of the lab partners will be anonymous (encouraging students to be honest), but the results reported to each student, so that he or she will be aware of the outcome. In this way the students will be aware of which aspects of their behavior are being monitored and can make adjustments, as needed. 

MEDICAL CLINICAL ANATOMY

MULTIMEDIA RESOURCES

Tufts University Science Knowledgebase (TUSK). Please familiarize yourself with the materials available when you go to “Medical School, first year”, then scroll to and select “Clinical Anatomy” on TUSK.

Note that lecture slides will be posted on TUSK in PDF format only – Because of copyright issues, Powerpoint presentations will not be posted..

Medical Clinical Anatomy Home Page: This site is the “home base” for the course, and contains general information. It has a list of useful websites and is linked to the Cross-Sectional Anatomy page, which may be viewed at:

cosmos.phy.tufts.edu/~rwillson/medgross/clinical_anatomy_2015.htm

The images at the Cross Sectional Anatomy Page are from the Visible Human project of the National Library of medicine. They have been selected by the Anatomy staff to assist the learning of cross-sectional anatomy during scheduled sessions in the Multimedia Resource Center (MRC).

We particularly want to draw your attention to new TUSK resources which were developed by Tufts Medical and Dental students over the past several years. These include clinical cases and sample questions, a Radiological Database, a Cross Sectional Anatomy page which includes images from the Visible Human Project of the National Library of Medicine, a Back Tutorial, and a link to Primal Pictures Anatomy software.

Students and faculty have suggested other helpful sites (Helpful Anatomy resources From Students) and these may be found in the folder entitled: Optional On-line Resources including Tufts On-Line Syllabus and Primal Pictures Software:

HOW TO USE THE SYLLABUS 

This course is unlike any other course you will take in Medical School, and probably any course you have ever taken. It is specifically designed to prepare you for your Step I Boards and for success in the third year clerkships. It will involve a significant amount of active-learning, a method of instruction in which students are responsible for generating their own knowledge base. Research has consistently shown that well-designed active-learning improves short and long term retention of information, improves critical and analytical thinking skills and encourages life-long learning – all of which are essential to clinical practice.

Because of its reliance on dissection as a primary means of instruction, gross anatomy has always incorporated an active-learning component. For this reason attendance in labs is mandatory except that you may have one unexcused absence during each of the sections – Extremities, Thorax, Abdomen and Pelvis. In this course you will acquire most of the core information of anatomy from one or more designated sources. A list of learning objectives, given at the beginning of each syllabus chapter, will help guide you through this process and provide you with opportunities to reinforce your understanding of the material.

The syllabus is designed to be used as a supplement and companion to the online materials (lecture slides and recordings) for Clinical Anatomy. Note that this year we have eliminated the paper syllabus and have, instead, provided an electronic syllabus (eSyllabus), accessible from TUSK, which has links to Netter Atlas images and other on-line material. The eSyllabus has been undergoing extensive revision each year to include specific course objectives for each lecture topic. It also contains, as an Appendix, a brief guide to each lab dissection which specific objectives and structures to be identified.

The syllabus is a compendium of:

• Practical information regarding the course
• Outlines, including learning objectives, for most of the course lecture topics
• Structure lists (“pink sheets” to be used as laboratory objectives and study guides for identifications on exams

You will quickly come to realize which lecturers have included their notes and images in this orange syllabus, and which have posted their slides on TUSK. It’s a good idea to preview each lecture by looking at the images in this syllabus or online. Many students print out their slides for lecture and bring them to class.

You may also wish to study the appropriate sections of the Online Syllabus for each region of the body: extremities, thorax, abdomen, pelvis, head & neck. Many students find it helpful to preview this material before the lecture in the indicated topic, and to reinforce the lecture content afterwards by reviewing it.

There are as many ways to learn anatomy as there are students in your class. Each of you will learn, through trial and error, which unique combination of the various resources: online syllabus and lecture material, Moore’s “blue boxes”, atlases, etc, works best for you. Sometimes the abundance of resource material can be overwhelming and intimidating. If you feel discouraged, do not hesitate to talk to the course instructors about your concerns. We will help you find the study strategy that is best suited for your needs.

Mastering anatomy is a challenge on many levels. It should also be a spiritually and emotionally rewarding experience. What many beginning students do not realize is that it can also be fun. We have tried to increase the likelihood that this course measures up to your expectations, and we hope that you will enjoy the ride.

RFW, November 2014

DISSECTION AND STUDY PROCEDURES

You will get the most out of a lab if you know what to expect before you dissect a region, can identify what you see in the process of dissecting, and are able to relate what you have seen to your general organizational and functional understanding of the human body.  We suggest the following procedure:

1. Before coming to the laboratory, read the relevant sections in the syllabus and in the Grant’s dissection manual.  Study the drawings in your atlas of the region to be dissected. Make sure that you have some fairly clear idea of the blood supply and innervation to the structures you are dissecting. (However, DO NOT simply memorize a list of structures, for example, muscles and their origins and insertions. Success in Anatomy requires making connections between anatomical parts that must work together and connecting that to what you are learning in other parts of this course).  In short, please come as prepared as possible.
2. Consult an articulated skeleton  before beginning dissection — orient yourself and locate important landmarks on the bones.  We also have an extensive collection of bones in the lab for you to study. Ask your instructor to guide you on some of the key landmarks on the skeleton for the day’s dissection.
3. Learn the terminology. Studying Anatomy is like learning a foreign language – it has its own vocabulary, grammar and syntax. Whenever possible, learn what components within the terms mean — as in Triceps brachii muscle — the three (Tri-)-headed (-ceps) muscle in the arm (brachii).  The Introductory chapter of the Moore textbook has a list of common terms that you should familiarize yourself with. . On TUSK we also list some common anatomical terms that you will encounter in this course.
4. Explore multiple ways of learning to find what works best for you and get different perspectives. Different people learn more easily in different ways; some students of anatomy will find pictorial material most useful, while others will rely on verbal descriptions, discoveries on the dissecting  table, or impromptu lectures in the laboratory.  Probably the best way to learn any large body of material is to try to explain it to someone else; you will benefit from searching out answers to questions raised by your partners in the laboratory.  Anatomy lab is by definition a team-based exercise.  Take advantage of that and learn with and from each other.