anatomy

Gross Anatomy Resources & Tips — Warning, You Can’t Unsee This Post

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Da Vinci would have been killed for Gross Anatomy if people knew, be happy you can do it as a requirement.
Da Vinci would have been killed for Gross Anatomy if people knew, be happy you can do it as a requirement.

Hello All,

So, a few weeks ago I finished Gross Anatomy, yay! This course is very time consuming, but interesting as long as you don’t mind smelling of formaldehyde and having bits of human flesh on your your clothes or exposed skin from time to time. In this post I’m going to share some tips that helped me get through. But, be fair warned, some of the links I’ll post are extremely graphic so view at your own discretion — some may even find this post somewhat traumatizing. If you’re not in medschool yet then these tips may seem hard to understand, but trust me once you’re there you’ll get what I’m saying. Your medical school (or future school) may have a different setup or variation, but here was our schedule for 3.5 months:

Written Test and Practicum

Unit 1 – Back and Limbs & Osteology (bones) Study & X-ray

Unit 2 – Thorax, Abdomen, Pelvis Cross Section (CT scans or cross sections)

Unit 3 – Head & Neck (Osteology, X-ray, CT scans)

Back and Limbs  — Specific Tips

Initially, I had a pretty rocky start with this course, my roommate (also a 1st year, but at HMS) also lamented on the difficulty of “Back and Limbs”. But, really the hardest part is just figuring out how to study for the course. In retrospect, the material is rather manageable, but this is only because you get better at the skill sets you need to do well in Gross Anatomy.

– Be familiar with the acronyms. Back and limbs isn’t conceptually difficult, after all you probable didn’t need to go to medical school to know that you had an elbow. However, what does make it hard is the jargin,  and depending on the staff you’ll hear more or less of it, in our case it was taught by someone who loved ortho so listening to their lectures was like listening to someone read out what they saw in their alphabet soup. This actually was probably the hardest part, try drilling these acronyms they use as quickly as possible so you can mentally join the discussion.

– The brachial plexus will be your first arch nemesis. At first, it really does suck, but it gets better trust me. However, it mostly gets better because other things you encounter are worse (evil cackle). You should must feel very comfortable with the brachial plexus, especially as it’ll show up on Step 1 (your board exam for MD and optional for DOs who often take their exam and Step 1). Interestingly, expect to get a lot of questions with the stem “Someone was stabbed at a bar, now they have this symptom, which nerves may be effected?”

– You must feel comfortable with the arterial and venous supply in this section. The best way is to draw them out in any way you see fit, as long as it’s accurate, then check with your trusted friends, TA, or professor to ensure the accuracy — there’s no point in studying something wrong. Lymphatics often isn’t very emphasized in this section, at least for us, but it was in the other sections.

– Osteology, what can I say, don’t forget the bones. Knowing the bones become more than a didactic exercise once you see a X-ray scan and are made to predict which muscle would be impaired.

Thorax, Abdomen, Pelvis — Specific Tips

– The thorax is rather straight forward, there’s a heart, lungs, a few nerves running through it and some vessels surrounding the ribs. You should feel confident about cardiac cycle (including fetal), and know the embryological origin of all of the heart and it’s associated vessels. The lungs aren’t bad either.

Pelvis — the bane of most 1st year’s existence. This video will help a lot!

https://www.youtube.com/watch?v=pbCdR1PumnU (not graphic)

– Go to lab frequently, don’t be afraid to get eerily close to the dissections so you can find obscure structures. Most people struggle with the pelvic floor, the layers, and what can articulate with what. Lymphatics are tested heavily in this section.

– Lymphatics are important in this section because they let you predict the spread of cancers — as a consequence, you should also be familiar with collateral blood flow so you know what happens if you were to remove that diseased section.

– If you need to read CT/cross sections, start building up your skills early in the course and you might actually learn to like this portion of the course. The easiest way I found was to start with one structure, for example the superior mesenteric artery, and trace it up and down (rostrally and caudally, or even medially and laterally). Going to lab, doing practice questions, and looking at scans are a great way to build a 3D image of the body in your mind. For cross sections I strongly recommend RAA Viewer

http://bearboat.net/RAAViewer/RAAViewer.html (graphic)

Screen Shot 2014-12-09 at 2.32.51 PM
When working in the thorax, abdomen, or pelvis be sure to start by asking yourself “Where am I?” Use every hint you have, then try to name structures, it’ll help you quickly eliminate/narrow down your answer choices.

 

– The intestines look like what they should only when they’re correctly placed in the body. After your dissection and during the test expect them to be in the silliest of positions, so get used to identifying landmarks to find your place as soon as possible. For example, the spleen or liver are typically the easiest to find, if you find those you can immediately orientate yourself. This also goes for the heart, you should be fine with seeing the heart in any position — don’t just practice in perfect positions, challenge yourself.

Head & Neck — Specific Tips

– The bad news is that this is probably the hardest section both in terms of dissection and identifying structures. The good news is that if you’ve been working hard in the other sections all of the skills you’ve previously acquired will come in handy — you’ll need to just have faith in that.

– Most of the had and neck is quite manageable, though you might feel differently once you get to the back of the pharynx. The key to this is to drill the section with friends, and videos like this help:

https://www.youtube.com/watch?v=-ER0nI__ZrQ (Acland video, graphic. Also, search Acland on Youtube for more sections, especially heart development)

– You should be very comfortable with seeing the head cut sagittally (split between the eyes), or even a coronal cut (typically from a CT scan). Learn the sinus drainage, and be able to identify them in both of these planes.

Screen Shot 2015-03-14 at 4.12.01 PM

– The trigeminal nerve is tricky, the best way to get to know it is to draw it out over and over again. Then, in lab while studying try to answer what would innervate this, what would a lesion manifest as etc.

– Don’t forget about development! It’s not that bad, there’s a lot of easy patterns that you’ll notice if you study them early enough, e.g. pharyngeal arches 1,2,3,4,6 (that’s not a typo) will develop into CN V, VII, IX, X (superior laryngeal), X recurrent laryngeal etc. That may sound tedious, but trust me, if you’ve made it this far you’ll probably know how to remember random information anyways. The key here is to make sure you drill what your school considers important, typically innervation is a skill you need to have.

– You must be a pro at certain things like cranial nerve lesions (aka memorize it cold). Also, a very repeated theme so far has been the Circle of Willis. This structure is important because cerebral accidents (clots etc) here are often disastrous. Be ready to identify each branch of the Circle of Willis and all of it’s immediate tributaries and confluences, it’s very important to be able to recognize the branches of the circle in different views as CTs can be rotated and given to you at any angle (just know the major views discussed in your course). You should also have a general idea of, where the arteries that make up the circle, this will probably be covered more in your neurology portion of your courses — having a good 3D idea of “what is next to what” will help in the written section when you need to eliminate wrong answers based on knowing a few clutch details and it makes the skull a less terrifying place. This site has a great key of what you likely need to know.

circleofW
http://w-radiology.com/mra-circle-willis.php
https://neuro4students.wordpress.com/pathophysiology/
https://neuro4students.wordpress.com/pathophysiology/

Here’s a link, you probably should also check out the other videos! This one in particular is of the infra temporal fossa (somehow my favorite section):

 https://www.youtube.com/watch?v=g7vUXNc9lrc (very, very graphic, I’m not responsible for your nightmares! If you’ve never done Gross Anatomy these videos will likely change your life.)

Overall Tips

– Gross dissection and studying are often disparate things, so don’t think just because you’ve scraped away all of the fat in the ischioanal fossa you’re pretty much done with the pelvic floor. There’s skills that you’ll gain in lab that’ll make dissections easier: loading scalpels, findings nerves from a rat’s nest, skinning etc. But, when you’re studying it’s a different mindset. Instead, go to lab with friends (try not going alone, if you’re the only one there it’s seldom productive) or join a group who’s studying and quiz each other/teach other. The more you go to lab, way before the test, the easier the practicum will be — once you get better it’ll also translate into your written scores as you incorporate more theory into practice. Of course, this doesn’t mean you should neglect your lab duties and screw over your teammates either, instead try to come prepared by knowing what’s important to look for during dissection so you can get out of lab as early as possible — for this it helps to show up to lab 10-15 minutes early and look at some examples (if your school has them), ask the TAs for tips or things to watch out for and you’ll be in much better shape.

– One of the biggest difficulties of Gross Anatomy (hell, all of medschool at the get go) is the language. Yes, you probably can process what it means when your professor says “It’s dorsal, yet slightly caudal and lateral to the cavernous sinus”, but if it takes you too long to stomach the lingo you’ll be out of luck because by the time you’ve translated they (your professor) has moved on. Likewise, learning some of the roots of the words, or conventions, makes things easier to remember — for example, the pudendal nerve’s function is easier when you know that pudendal stems from a word referring to the “gross (as in yucky) region”.

– Don’t be afraid to be pimped, you may think you’re getting picked on by your anatomy TAs, but it’s really to help you. You’ll go from getting pimped and hating it to being frustrated because you can’t find anyone to “challenge” your knowledge by pimping you. The best way to learn the lab part of the tests, and link it with the written background, is to drill with others and figure out what you don’t know.

– Bring a “dirty notebook”, a notebook and pen that you don’t mind gets greasy from human fat or intestines etc. When you go to study or during reviews, jot down what you didn’t know or misidentified as a “to-do list”. Have someone knowledgeable help you find items  on your “to-do list, don’t forget to ask how they find it so you can do it on your own too. Next, go find those structures on at least 3 other bodies. For one section I went gun-ho and did almost all the bodies, it was by far my best section.

– Attend every speed review your school hosts. If your school doesn’t have one, or only does a speed review for the 1st section etc., then get together with your classmates to run your own. It’s tedious, but making a few people into resident experts in certain areas (the orbit, the neck etc.) and then helping each other is a good way to save time and learn more. Once you’ve seen a speed review you’ll know what I mean. But, above all else remember that a speed review isn’t to teach you, it’s to let you know what you don’t know so you can go work on it.

– Make sure to ask your predecessors for tips, they’re usually more than willing to save you the pain they encountered.

– Atlases: atlases are important for references and understanding of relationships, e.g. which arteries branch of what other arteries. But, keep in mind that the body will do whatever it feels like and so will often violate a pristine Netter Atlas drawing, this is especially true once you enter the abdomen and pelvis. So, an atlas is a great supplement, but it’s not a replacement for getting dressed in scrubs and heading to lab with a probe and tracing structures back.

Most importantly, you don’t need to love Gross Anatomy, but because someone gave their body to you be sure to respect it.

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