A hands-on learning experience that has been a cornerstone of medical education for hundreds of years has undergone a recent advancement at East Tennessee State University’s James H. Quillen College of Medicine that puts the college on the leading edge of technology.
The Quillen College of Medicine has integrated iPads into the gross anatomy lab in a way that few U.S. medical schools could match. The school designed special mechanical “arms” that hold an iPad in place at each anatomy dissection table, providing students with a learning tool that is incalculable in its worth.
“I don’t think any other school in the country has what we have,” said Dr. Thomas Kwasigroch.
No one is more familiar with the subject of human gross anatomy at Quillen than Kwasigroch. Known by many as “Dr. Kwas,” he is the director of the medical human gross anatomy program at ETSU and has taught every medical student who has graduated from the school. The study of a human cadaver remains the foundation of the Medical Human Gross Anatomy and Embryology course – a class that every first-year medical student must take and pass – but the iPad learning center puts the experience on another level.
The project came about through the vision of Dr. Caroline Abercrombie, input from medical students and a year’s worth of development. The loyalty that develops among family of Quillen alumni even played a role as well. Abercrombie, the director of the anatomy lab at the College of Medicine, developed the iPad project and wrote a grant proposal that won approval and funding from ETSU’s Technology Access Fee program.
“Each student in gross anatomy learns from day one that the cadaver is their first patient,” Abercrombie said. “It can be an overwhelming experience. There’s so much to learn about the human body, and you have only so much time to learn it. When you’re studying anatomy, it’s difficult for students to visualize certain aspects because the systems are so complex. You have to have visual explanations, and in the past, that meant referring to textbooks. Having an iPad at each anatomy station puts everything in one place – course notes, high-definition illustrations – and students also have three-dimensional images to help them identify structures."
Other leading U.S. medical schools – such as Duke University and Stanford University – have integrated iPads into teaching the subject. Abercrombie and Kwasigroch said ETSU went a step further with its design by mounting the tablets so that every team of four students has one in place at all times.
Each iPad has several applications, including a detailed atlas of the human body. In addition to the tablets, the laboratory is equipped with several widescreen monitors throughout the room, and wireless technology allows instructors and students to access – individually or as a group – not only anatomical images but also course notes and student presentations.
Medical students have studied anatomy for years through textbooks, but the foundation of the learning experience – dissection and examination of a cadaver – can wreak havoc on paper. Fluids that inevitably collected on pages often meant students had to double down when it came to gross anatomy.
“Medical textbooks are expensive,” Abercrombie said, “but students taking gross anatomy often bought two copies of the book for class: One to keep in the lab and one to keep at home for study.”
The lab copies often got donated to the lab after students finished with the class. The books are usually worn down at least, and Jon Miller said the hurdles are sometimes greater. Miller is a second-year student at Quillen.
“I got used to flipping through textbooks where the pages were stuck together,” Miller said.
Miller was among the students who provided perspective during the development process. To build the arm that is mounted above each anatomy station, Kwasigroch and Abercrombie turned to Don Combs, a Maryville metal fabricator who had labored on behalf of the school before. Combs, whose son Josh is a Quillen alumnus, built a large grill for College of Medicine cookouts. This time he came through with a high-tech device mounted in the ceiling that slides the full length of the anatomy table and swivels so the iPad has a wide spectrum of articulation. The mount also has a transparent shield to keep liquids off the tablet display – another Quillen feature that most anatomy labs don’t have.
“The case, the arm, the mount; that was all designed by us, and Don was able to take our specifications and engineer something that works perfectly,” Abercrombie said.
Anuj Patel is a first-year medical student who would second that thought. Throughout gross anatomy, he and the three other students on his team will map the body with the same cadaver. Their work isn’t always done in the boundaries of class time.
“One of the best things is that facility is open 24/7 to students, so I can come in at 6 in the morning or 8 at night if I need to,” Patel said. “But if I come back at night, there are no instructors there – that’s when the iPad is most useful to me. There’s a big shelf of reference books there, but those books are often messy, and I don’t want to get my lecture notes out and end up with the same problem. Having the iPad there as a reference tool is great. It’s a big differentiator.”
Abercrombie pointed out that anatomy isn’t only about the individual student – it’s about a team of students. They must confer together and present cases to their peers. Delivering case studies is a skill that physicians will use throughout their careers, and increasingly, iPads are a preferred platform – so learning the technology now will carry over to when they become doctors. Abercrombie said the tablets will be a particular advantage for students when they present their big, end-of-year Cadaver Case Presentation – a group study on diseases and pathology found in their first patient.
“It’s almost like a mini-grand rounds,” Abercrombie said.
Miller, too, emphasized the advantages realized by each student group.
“You’re able to work better as a team, and it speeds up the whole process,” Miller said. “Time is crucial when you have so much to learn and only so much time in which to do it. If you’re able to get a better learning experience in a shorter amount of time, ultimately you’ll retain that knowledge better.
“It’s so foundational for you to get a good grasp of anatomy, because as a physician, you’ll be referring to these structures the rest of your life.”
Patel, who earned his undergraduate degree at ETSU, said with a laugh that he senses a bit of envy from classmates who came before him. But all of those Quillen students, regardless of class, still share a common reference point where gross anatomy is concerned. No matter the technology, nothing rises above the basic human component.
“The human cadavers we work with; they’re not just a tool we’re using,” Patel said. “We’re taught from the start to treat this person as you would any other patient – with respect and kindness. At the end of the semester, we’ll have a ceremony that’s something like a burial ceremony. It’s an important thing to do. We’ve gained a wealth of knowledge that we’ll need to practice medicine, knowledge we gained from someone we didn’t know but gave so much to us.”