Teaching Anatomy: Effective Use of Modified Team-Based Learning Strategy

Abstract

In the twenty-first-century medical education, the integration of basic sciences in the preclinical medical curriculum has caused a reduction in time to teach anatomy. Team-based learning (TBL), which engages students in their learning, is an ideal pedagogical strategy to teach anatomy despite its conceptually challenging nature. TBL combines various aspects of the adult learning theories in a unique way, so that learning is self-directed but guided by the faculty. The model of TBL focuses on learning defined by pre-class preparation that utilizes a content-specific learning/study guide, followed by in-class team discussion. Team discussion is an effective form of peer teaching; session content is discussed and clarification questions answered that allow students to reflect upon their learning and remediate any content-specific knowledge deficits. There is improved learner engagement with the course content that allows development of higher levels of learning—application, analysis, and evaluation. Adopting TBL improved class attendance and performance.

Appendix

Completion of this TBL will require the use of designated figures and text in Clinically Oriented Anatomy (COA), Moore et al., 8th edition [28], and Medical Embryology, Sadler, 14th edition [29].

Phase 1: Reading Assignment, Pagination from Textbooks

Heart: Anatomy to Comprehend

After completing the section on pericardium, you should be able to:

• Describe the fibrous pericardium.

• Distinguish parietal and visceral layers of the serous pericardium.

• Define the transverse pericardial sinus.

Content-Specific Learning Topics: Fibrous Pericardium and Serous Pericardium

• Use Fig. 1.43, p. 129 (COA), to observe that the tough external fibrous pericardium covers the cellular serous pericardium. Recognize that mesothelium (simple squamous epithelium) forming the parietal layer of serous pericardium lines the inner surface of the fibrous pericardium. Observe at the origin of the great vessels that it reflects onto the heart as the visceral layer of serous pericardium.

• Use Fig. 1.48 (B), p. 131 (COA), to recall that fusion of the pleuropericardial membranes divides the thoracic cavity into the pericardial cavity and bilateral pleural cavities, and use Fig. 1.48 (C) to observe after the division that the membranes form the fibrous pericardium.

• Use Fig. 1.32, p. 110 (COA), to recognize that the pericardium (aka pericardial sac) fuses to the central tendon of the diaphragm, and use Fig. 1.33, p. 111 (COA), to envision continuity of the parietal and visceral layers of serous pericardium at the roots of the great vessels.

• Use Fig. 1.46, p. 131 (COA), to recognize that the transverse pericardial sinus (arrow) is a pathway posterior to the intrapericardial parts of the aorta and pulmonary trunk and anterior to the intrapericardial parts of the superior vena cava (SVC) and pulmonary veins.

Embryology to Comprehend

After completing the section on the heart tube, you should be able to the following:

• Summarize the formation of the interatrial septum

• Summarize the formation of the interventricular septum

Content-Specific Learning Topics: Formation of the Atrial and Ventricular Septa

Use Fig. 13.15, p. 172 (ME), to determine that formation of interatrial and interventricular septa completes the differentiation of the primitive atria and ventricles. Recognize that formation of the septa involves mesenchymal cell-derived endocardial cushions (ridges) and narrow tissue strips that completely or incompletely separate the chambers.

Phase 2: In-Class Discussion, iRAT and tRAT

Questions for Application of Knowledge

• 1. From Cardiac Tamponade and Pericardiocentesis, pp. 133–134 (COA): Why can cardiac tamponade be fatal and how is pericardiocentesis normally performed?

• 2. From Surgical Significance of Transverse Pericardial Sinus, p. 133 (COA): How do cardiac surgeons utilize the transverse pericardial sinus?

Examples of questions (based on reading assignments, topics for discussion, and application of knowledge) in the module exam:

Case

A 21-year-old college student on spring break fell from the balcony of his hotel and sustained blunt chest trauma. He was rushed to the ER, and very weak heart sounds, reduced cardiac output with declining blood and pulse pressures, bilateral jugular distension, and respiratory distress were detected.

The patient’s symptoms most likely resulted from:

• A. Hemothorax

• B. Cardiac tamponade∗

• C. Cor pulmonale

• D. Deep vein thrombosis

• E. Pancoast’s syndrome

Case

A 61-year-old female complains to her physician about tiring easily and shortness of breath on exertion. Auscultation of the chest detected a diastolic murmur and a collapsing pulse was detected.

The patient is most likely suffering from:

• A. Aortic valve insufficiency∗

• B. Mitral valve stenosis

• C. Diseased left ventricular papillary muscle

• D. Pulmonary valve insufficiency

• E. Heart bundle block

Case

An underdeveloped 3-year-old child was brought to this country to correct a congenital heart defect. The child had dyspnea and often suffered from pneumonia. Surgery corrected the congenital defect; however, several days later, the child was diagnosed with a heart block.

The surgery was most likely performed to correct:

• A. An atrial septal defect

• B. A ventricular septal defect∗

• C. A patent ductus arteriosus

• D. A double aortic arch

• E. Coarctation of the aorta

Phase 3: Inter-Team Case Discussion (Example of a Case)

Case

A 67-year-old man, who has been a smoker since the age of 15, is seen at the family clinic.

History of present illness

Numbness and tingling on the medial side of his right forearm and hand and swelling in the right supraclavicular region. He also started to notice that his voice was becoming hoarse.

Physical exam

Edematous face and neck, puffiness around the right eye, and right jugular venous distension. Exhibits ptosis of the right eye and pupillary constriction.

Imaging

Chest X-ray shows large tumor of the right apical lobe.

Discuss and explain the reason(s) for the following:

• 1. Numbness and tingling on the medial side of his right forearm and hand

• 2. Voice becoming hoarse

• 3. Swelling in the right supraclavicular region

• 4. Edematous face and neck, puffiness around the right eye, and right jugular venous distension

Phase 4: Module (Thoracic Structures) Exams with MCQ (Examples)

Case

A third-year medical student was assisting in “C” section at the university hospital. The attending physician asked the student to describe the blood pressure changes that occur in a neonate.

Right atrium	Right ventricle	Pulmonary trunk	Left atrium	Left ventricle	Aorta
A. Increases	Increases	Increases	Increases	Increases	Increases
B. Increases	Increases	Increases	Decreases	Decreases	Decreases
C. Increases	Increases	Decreases	Increases	Increases	Decreases
D. Decreases	Decreases	Decreases	Decreases	Decreases	Decreases
E.∗ Decreases	Decreases	Decreases	Increases	Increases	Increases

Case

A 65-year-old male, living alone, was found dead in his apartment. Postmortem examination of the heart showed necrotic changes limited to the anterior two-thirds of the interventricular septum.

If chronic coronary artery disease had resulted in arterial occlusion, the artery most likely occluded was the:

• A. Left coronary artery

• B. Left circumflex artery

• C. Right coronary artery

• D. Marginal artery

• E. Left anterior descending artery∗

Case

A 52-year-old female with dyspnea came to the ER. During examination, crackling sounds (rales) were heard when the stethoscope was positioned on the right midclavicular line at the level of the fourth intercostal space, and acute bronchitis was suspected.

The location of the acute inflammation and resulting rales was most likely the:

• A. Lateral bronchopulmonary segment∗

• B. Anterior bronchopulmonary segment

• C. Apical bronchopulmonary segment

• D. Anterior basal bronchopulmonary segment

• E. Lateral basal bronchopulmonary segment