THE ANATOMICAL RECORD (NEW ANAT.) 269:81– 88, 2002 SPECIAL ARTICLE The New Face of Gross Anatomy JOY S. REIDENBERG* AND JEFFREY T. LAITMAN The nature of anatomy education has changed substantially over the past decade due to both a new generation of students who learn differently from those of past years and the enormity of advances in anatomical imaging and viewing. At Mount Sinai School of Medicine, our anatomy courses have been designed to meld classic dissection with the tools physicians and surgeons will use tomorrow. We introduce students to the newest technologies available for viewing the body, such as minimally invasive approaches, ultrasonography, three-dimensional visualizations, multiaxial computerized image reconstructions, multi-planar magnetic resonance imaging, and plastinated prosections. Students are given a hands-on, team-building experience operating laparoscopes in the laboratory. A great strength of our program is the important and active participation by faculty from 15 different basic and clinical departments, including several chairs and voluntary faculty. This interdisciplinary approach brings to our students direct, one-onone encounters or presentations by our finest physicians and surgeons and our core anatomy faculty. In addition, the presence of many teaching assistants drawn from upper classmen and advanced graduate students adds an additional, vibrant dimension. Our anatomy programs for medical/graduate students and postgraduates are structured around three simple principles: (1) it is a privilege to teach, (2) we enlist only passionate teachers, and (3) it is our role to instill appreciation and respect for human form. Anat Rec (New Anat) 269:81– 88, 2002. © 2002 Wiley-Liss, Inc. KEY WORDS: teaching; education; gross anatomy; laboratory; medical curriculum; imaging; technology; laparoscopy; CT; MRI; three dimensional; computer-assisted learning INTRODUCTION The old anatomy is dead. Long live the new anatomy. For centuries, anatomy Dr. Reidenberg is Associate Professor of Anatomy and Functional Morphology at the Mount Sinai School of Medicine (MSSM) in New York. She teaches gross anatomy for medical and graduate students, is coordinator for all prosection programs, directs electives in comparative anatomy, and teaches in resident and postgraduate courses at MSSM. She was the 1999 recipient of the Basmajian–Williams and Wilkins Award from the American Association of Anatomists (AAA) for Excellence in Teaching and Research by a Gross Anatomist. Dr. Laitman is Professor and Director of the Center for Anatomy and Functional Morphology, Professor of Otolaryngology, and Director of Gross Anatomy at MSSM. He was the first recipient (1987) of the AAA Basmajian–Williams and Wilkins Award from the AAA. *Correspondence to: Dr. Joy S. Reidenberg, Center for Anatomy and Functional Morphology, Box 1007, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029-6574. Fax: 212-860-1174; E-mail: joy.reidenberg@ mssm.edu DOI 10.1002/ar.10076 Published online in Wiley InterScience (www.interscience.wiley.com). © 2002 Wiley-Liss, Inc. has been taught by means of numerous hours of cadaveric dissection supplemented by mostly factual lectures. Poor to average teachers implanted some facts and much tedium. The occasional gifted, enthusiastic one opened eyes and gave a template for life-long interest. So, is this not the world we still face? Although the teaching pool is probably the same, and the intelligence of our students always high, some factors have changed radically. First, we must recognize that the medical students of today are products of the “interactive generation.” Watch, for example, an 8-year-old “surf the net” with the adroitness of a fine surgeon and one soon realizes they are from a different planet than we are. The world of our students is multimodal and stimulus dependent. The concept of “come to the lecture” or “read the book” as a primary directive is rapidly becoming antiquated. Second, we are in a time of extraordinary anatomical expansion. The past few decades have witnessed an explosion of new imaging and minimally invasive modalities that have brought to the table new and wonderful ways to visualize structure. These modalities range from laparoscopic viewing, enhanced magnetic resonance imaging (MRI) and computed tomography (CT), to three-dimensional (3-D) visualizations. Opportunities have been opened up that were previously only pipe dreams. What to do? First, it is most important not to fight forever the losing battles of “generations have studied this way” or “this is the only way to learn the body.” For our generation, yes. For the princes and princesses of the Internet, Web, and portable computers, maybe not. Call it what you will, the medical students of today are “wired differently” and receive information in a different manner. Yes, there will always be the gifted, budding orthopaedist who spends every extra minute in the lab, or the future Chief of Neurosurgery who brings you articles by Harvey 82 THE ANATOMICAL RECORD (NEW ANAT.) Cushing in the first week of class. But the greater majority of average students can no longer solely respond to “cut,” “read,” and “listen.” This has not been an overnight occurrence. We have watched this phenomenon occur over the past decade. It seems to us that many students suffer from ADD (Anatomy Deficit Disorder), and we have tried to create our educational programs to address the issues and opportunities mentioned above. Our particular solution has been to keep the central while modifying much of the periphery. For us, the challenge has been to maintain a robust dissection experience while placing that in a dynamic, clinical sphere by enlisting many of the best physicians and surgeons. We have also changed our modes of presentation to add the powerful new technologies and visualizations science has made possible, and medicine in the 21st century will totally embrace. For our faculty and staff, anatomy is indeed “the once and future king” of medical education. It is our desire to transmit the energy and excitement of our science and its new advances to our students. We try to address our changing student preparation and attitudes by creating an anatomy experience in language and modalities they can embrace. We have had to shake some branches— even the tree—a little hard to do this, but we believe our approach is working. The following is an overview of some of the methods we have tried in the effort. GROSS ANATOMY: NUTS, BOLTS, AND OUR PLACE IN THE COSMOS Our school, Mount Sinai School of Medicine in New York, has recently undergone a major curriculum reform (see also Drake, 1998). After 2 years of “spirited” discussions, we decided that gross anatomy should continue as a separate course covering, by sequential dissection, the entire body. Although it was a goal of our new curriculum to “integrate” various courses, gross anatomy was already believed to be integrated in that many of the clinical sciences and faculty were already significantly involved (see below). Our course runs from the end of August through the end of December and consists of approximately 140 h of class time; including dissection, in-laboratory demonstrations, lectures, and discussion groups. Our histology and embryology courses are taught as separate entities from gross anatomy, although there is considerable “cross-talk” in the planning of these. For example, our small embryology course (20 h) covers fertilization, early stage development, and body cavity and organ formation, whereas aspects of head and neck (e.g., branchial arches, skull development) are done in gross anatomy. Similarly, aspects of the histology of the eye are done in gross anatomy during the day we devote to fresh (from sheep) and cadaveric eye dissections. Our gross anatomy course for the 2001–2002 first year medical student The world of our students is multi-modal and stimulus dependent. The concept of “come to the lecture” or “read the book” as a primary directive is rapidly becoming antiquated. class (numbering 106) is run in conjunction with our human morphology course for graduate students (3–10 per year). The graduate students come from both our Graduate School of Biological Sciences at Mount Sinai and from the New York Consortium in Evolutionary Primatology, a National Science Foundation–funded training program for Physical Anthropology students from New York University, Columbia University, and the City University of New York, as well as having come from other schools such as Rutgers University, the State University of New York at Albany, and the University of Paris. The graduate students add a different and vibrant dimension, bringing their particular interests in development, comparative anatomy, and evolution to our course. Lastly, but of importance, is that SPECIAL ARTICLE faculty from our department play an integral role, and are deeply involved in all decision-making educational bodies at our school. These include being on Executive Curriculum and Executive Admissions Committees to Year and Course Organization Committees. Involvement has been very important in allowing us to chart the direction of our educational mission. CLINICIANS: HERE, THERE, AND EVERYWHERE One of the hallmarks of our first-year medical school course is the large number of clinical faculty that eagerly participates. To understand this, it is important to understand our anatomy program at Mount Sinai. Anatomy here is alive and well, with many courses on all levels running yearlong. Most of these are on the postgraduate level and often involve participants world-wide. Our faculty oversee, organize, or teach in many of these. Without us—no courses. These involvements have enabled our faculty to know and work seamlessly with “clinician-anatomists” throughout our school—many of whom have, or will have, secondary appointments in anatomy. We enjoy assisting them, and they cannot wait to assist us. Do not underestimate your clinical colleagues. They enjoy teaching medical students and are often the strongest supporters of anatomy education and educators. An added benefit to clinicians has been that we support and aid in their advancement and promotions at our school. Clinicians Add the “Spice of Life” to a “Dead Subject” Gross anatomy laboratories have the potential to be long and tedious when the activity is limited simply to reading from the dissector and following its instructions. Students are far more motivated when clinical applications are presented straight from the source: the best practicing clinicians themselves. In our gross anatomy course, we encourage the voluntary participation of surgeons and physicians side-by-side with the anatomy faculty in laboratories. The clinical SPECIAL ARTICLE THE ANATOMICAL RECORD (NEW ANAT.) 83 latest breakthrough presented in the news). The benefit to the gross anatomy faculty is the team-like atmosphere of working with clinical colleagues who both value teaching and tangibly validate a practical need to know anatomy. ANATOMY GOES HIGH TECH: AUDIO-VISUAL LECTURES AND DEMONSTRATIONS Figure 1. The ultimate “small group session” occurs at each dissecting table. When clinicians such as Dr. S. Dikman, Pathology (center), make learning fun, students remember the important information. faculty does not replace the anatomy faculty, but rather augments it. Although both clinical and anatomy faculty move among the student tables asking anatomical questions, the clinical faculty’s special role is to bring a clinical focus to the material being studied. They point out applications related to the regions being dissected and encourage and answer the students’ medically oriented questions (Figure 1). They give heightened purpose to learning the material. As many of the participating clinicians have just lectured to the class before laboratory, there is a built-in level of interest on the part of the students. They are thrilled to have the opportunity to meet the lecturer one-on-one and ask their questions in the less formal setting of laboratory. Our program has been so successful that we have many more volunteers than we can reasonably accommodate in our laboratory. We thus limit participation only to invited individuals. This has served two purposes: (1) the students are exposed to the best clinician-educators (teachers that provide a poor educational experience are not invited back), and (2) the invitation itself becomes an honor and a mark of one’s value as a clinician-educator. This coveted status has even created some competition among the clinical faculty. All clinical lecturers are invited to labora- tories. Additional clinicians are invited only to laboratories relevant to their area of expertise. (If they do well they may even earn the privilege of giving a demonstration or lecture.) The benefit to the students is immediate: they are exposed to dynamic individuals who bring the anatomical sciences to life. An additional bonus is that the students get to meet many individuals important to their future careers (e.g., chairmen of departments; Figure 2) or world-renown clinicians (e.g., they may have just treated a famous person or had their No anatomy course worth its scalpels is complete unless it presents anatomy as viewed through the latest diagnostic and procedural imaging technologies used by practicing clinicians today (e.g., CT, MRI, ultrasound, minimally invasive views through scopes; see also Haines et al., 2002). Video filmed during clinical procedures is often used to supplement a lecture by demonstrating live anatomy. One area of new technology is that of viewing the body from within through the use of various scoping procedures (e.g., video images of live patients obtained through a laparoscope, thoracoscope, bronchoscope, arthroscope, or endoscope). These demonstrations are particularly well suited for video projection (Figure 3). A combination of exciting speakers and engaging visuals is the perfect recipe for a successful, stimulating lecture. Although we strive to present lecturers that transmit our enthusiasm for the subject, we also encourage variations in presentation medium and use of the latest audio-visual tech- Figure 2. Chairmen do smile—at least in anatomy lab. Dr. L. Hollier, Chariman of Surgery (left), and Dr. A. Schiller, Chairman of Pathology (right). 84 THE ANATOMICAL RECORD (NEW ANAT.) nologies whenever possible. Digital imaging has opened new dimensions in presentation possibilities for the lecturer, including animated overlays, labeling, and embedded video. Lectures are also supplemented with teaching tapes or compact discs (e.g., a demonstration dissection complemented with various visual aids) that illustrate difficult anatomical concepts in a visually stimulating and understandable format. These materials are often used to elaborate on regions we do not dissect in detail in our course due to time constraints or those that are particularly difficult to conceptualize. They have the added advantage of being available for viewing in the library or on-line on our Web site at any time. Live closed-circuit televised projection is another medium frequently used during our course to give a physical demonstration. The students view the televised image on a large screen in the auditorium and can hear and respond to the lecturer in real-time by means of a two-way microphone and speaker hook-up between the auditorium and the video demonstration room. The lecturer can use this medium to give an audio-visual tour of a dissection in progress, perform a clinical procedure (e.g., a bone marrow aspiration), or show close-up images of a patient or volunteer presentation (e.g., testing eye movements or neurological reflexes). The advantages of the live video demonstration are many. All students receive the same information from the dissection/presentation in a short amount of time. The zoom lenses of the cameras provide views equivalent to close-up, inperson viewing of the specimen. This medium provides an interactive audio-visual experience for the students, including the opportunity to ask questions and hear the responses of the demonstrator. Closed-circuit live televised projection is also used in the laboratory setting to lead real-time guided tours of special dissections. The live guided tours consist of a demonstrator narrating the dissection while the students simultaneously perform their own dissections. The demonstrator shows where to make the cuts and points out relevant features, and then waits for the students to perform the same cuts. A live demonstration has advantages over a prerecorded tape in that it both ensures that the pace is geared toward the students’ actual pace of dissection, while allowing interactive questions and answers. This approach is of particular value for those laboratories in which we dissect fresh animal organs, such as bovine hearts or ovine eyes, which give a valuable added dimension to their cadaveric dissection. We find these exercises extremely helpful, as the fresh material demonstrates certain features of the anatomy not easily appreciated in the preserved state. A similar arrangement is used for demonstrating the 3-D anatomy of the skull, with each student handling a dry skull while following the demonstrator on the closed-circuit televisions. This medium also allows the demonstrator to augment the presentation by showing close-up views of unique specimens A combination of exciting speakers and engaging visuals is the perfect recipe for a successful, stimulating lecture. not available to each individual student (e.g., teaching skulls featuring “exploded” or Beauchene cranial bones, windows cut into sinuses, ear ossicles, painted vascular impressions, neural foramen, deformed or immature skulls, or even comparisons with animal skulls). This closed-circuit medium is flexible enough to allow demonstrators to augment their presentation with projection slides depicting special views (e.g., diagrams, histology, pathology) or prefilmed video clips of surgical procedures (e.g., lens replacement, thoracotomy) transmitted to the laboratory television screens (Figure 4). BRINGING THE FUTURE INTO THE ANATOMY LABORATORY: HANDS-ON LAPAROSCOPIC DEMONSTRATIONS As minimally invasive surgical approaches are becoming the standard in SPECIAL ARTICLE many areas, a new generation of clinicians needs to be trained to view the body from within (e.g., through various scoping procedures). We believe it is important to introduce this method of viewing the body in the beginning of medical school, starting with the gross anatomy laboratory, rather than waiting until third- or fourth-year surgery rotations or internship/residency programs. We introduce medical students to a hands-on demonstration of the tools of the trade by allowing them to see and participate in abdominal laparoscopic examinations of cadavers. The use of cadavers allows the luxury of no time pressure, no restrictions on the degree to which the organs can be manipulated, and the familiarity of seeing the structures in the same state of preservation as they appear in the students’ regular cadaver dissections. First, the students observe a demonstration of the laparoscope and surgical tools and are given a tour of the abdomen through the TV monitor projections from the laparoscope. Next, each dissecting table group (4 –5 students) is allowed to handle the laparoscope and surgical equipment (Figure 5). The surgeon directs them in a task to find a landmark (e.g., falciform ligament) and grasp and manipulate an organ (e.g., gall bladder). In this way, the students not only learn to use the tools and perfect their hand-eye coordination, but also they learn an important lesson in teamwork. The students handling the surgical equipment must interact and coordinate with each other to accomplish their task of manipulating the organ correctly, while all are dependent upon the TV monitor views afforded by the student operating the laparoscope. The purpose of visualizing by means of laparoscopy goes beyond learning the technique, however, to teaching our students the importance of conceptualizing structure in a different manner than that presented in standard dissection. We expect them to be able to understand the anatomy of the abdomen, thorax, or ear when shown a laparoscopic, bronchoscopic, or otoscopic view. Indeed, we now test them on these views as we regularly do with CT, MRI, or ultrasound images. SPECIAL ARTICLE Figure 3. Medical students are introduced to laparoscopic views of living anatomy, such as this image of a gall bladder from a patient (courtesy of Dr. B. Salky, Surgery). SCHOOL-FACULTY PARTNERSHIP: SUPPORTING NEW INITIATIVES Several of our teaching faculty (both anatomists and clinicians) applied for and received Gaisman Teaching Enhancement Awards from Mount Sinai to develop new teaching modalities for the gross anatomy course. One project, spearheaded by a radiologist, uses the latest technologies in radiographic imaging: multi-planar MRI views. This technology enabled the students to view the anatomy of an extremity through sequential layers of magnetic resonance images. The ability to stack the images and then view them sequentially from any axis gives the impression of “moving” through the planes. This method helps the students visualize 3-D relationships, such as the changing lateral to medial location of the sartorius muscle as one views it superiorly to inferiorly in sequential transverse planes. When used in a lecture, this methodology presents a spectacular and dynamic demonstration of the relative positions of structures. A second Gaisman Award to one of our ophthalmologists funded a new modality for visualizing anatomy of the eye and orbit in three dimensions. A special setup of stereo slides, projection screen, and polarized glasses allowed the students to take a virtual 3-D tour of the anatomy of the region. This experience not only made the lecture topic exciting but also created a distinctly fun atmosphere as the whole class felt as if they were on a field trip to Disney World with their 3-D glasses. It’s hard not to laugh THE ANATOMICAL RECORD (NEW ANAT.) 85 when you witness students reaching out to grab the ciliary ganglion as it appears to dangle in space just a few inches in front of their heads. A third Gaisman Award to one of our anatomists allowed for the development of a permanent bank of catalogued dissections created by anatomists, teaching assistants, and residents. The prosections provide alternative views to those performed in laboratory and often feature complex or fragile structures. Although we have had an active prosection component of our first-year medical school course for some time, much of the material became unusable over time and with handling due to exposure, spoilage, and excessive manipulation. The project currently under way uses plastination of these new dissections to preserve them and enable their handling in a laboratory environment. Although labor intensive to prepare the dissections, the end products have proven most useful. Indeed, material can be left out without fear of desiccation, decomposition, or damage. They can also be made available for resident review and study. We are in the process of creating an intranet Webbased catalogue depicting images of the available prosections so that faculty, students, and residents will eventually be able to request access to specific material in advance for study, review, or demonstration use in educational courses. COMPUTER-ASSISTED INSTRUCTION Imaging technologies are an important tool for ascertaining the anatomy of a living person. Thus we believe it is imperative that students have familiarity with viewing anatomy in these media. To facilitate this, we have always had radiograms (x-ray images) posted on light boxes in the gross anatomy laboratory. This is of great value, as clinical and anatomy faculty can discuss scenarios one-on-one with students. A few years back, we developed coursespecific computer-assisted instruction (CAI) modules, which are available in our school library. We have now extended this to have these modules as a Web-based educational supplement to our course available to every student’s personal computer. (See Heidger et al., 2002 regarding similar web-based supplements for histology.) Our CAI program now consists of digital radiographic images that can be viewed with or without labels (Figure 6). The students use the CAI medium to learn, review, and test themselves on radiographic anatomy. A new initiative for next year will be interactive CAI programs based on the creative work of a new junior faculty member who has developed 3-D rep- Figure 4. Dr. A.G. Thomas, obstetrics and gynecology, demonstrating videos in the laboratory, showing female reproductive tract anatomy by means of laparoscopic viewing in live patients. 86 THE ANATOMICAL RECORD (NEW ANAT.) Figure 5. Dr. D. Herron, Center for Minimally Invasive Surgery, guides students in operating the laparoscope and surgical instruments on a cadaver in the laboratory. resentations of the paranasal sinuses (Figure 7). Students viewing representations of these spaces can rotate them along multiple axes. These will eventually be used to augment in-laboratory endoscopic examination of the region in cadavers. This approach to visualizing such traditionally difficult to see spaces will considerably enhance our students’ appreciation of the material. LEARNING FROM THEIR PEERS: THE VALUE OF THE TEACHING ASSISTANT Our mission as teachers is to reach out, connect with, and enlist students. We all know that faculty can reach many students, but not all. Some students are intimidated by us, too nervous because they actually like us (it can happen), or love the material and do not wish to appear weak. One of the greatest vehicles to connect with students can be by means of their own peers. In addition to the above, the greatest education in anatomy (or any other course) a student can have is to teach it. That’s when you really learn anatomy. From this concept was born our teaching assistant (TA) programs, which have become some of the most sought-after electives in our school. These programs have been so success- ful that, in our redone “new” curriculum, time has been specifically allotted to allow second-year medical students the time to be our anatomy TAs. Of our class of 106, we regularly have approximately 30 (sometimes 40) applicants competing for 15 positions (Figure 8). Our TA program has grown to have several components. First, our second-year students apply to be TAs and our faculty chooses from the pool. Our medical students can apply to be “in-class” TAs, radiographic-CAI TAs, or prosection TAs. TAs in the latter two categories may come to lab if they wish (most do). They are not, however, mandated to do so, as their time SPECIAL ARTICLE is being spent in updating/creating CAI modules or preparing and demonstrating prosections, respectively. Due to the success of the secondyear TA program, we instituted a Senior TA experience this past year. In this program, the faculty invite a select group of former TAs (now in the fourth year) and offer them the opportunity to serve as Senior TAs. We chose one student last year and two students this year. These TAs have different responsibilities, including assisting in planning the course and in creating and administering examinations. They also give several review sessions to the class. Our second- and fourth-year TAs have many roles. One of the most important is as visible, positive role models for the entering class. As one of our students told us: “Seeing the army of TAs at the outset made me feel that if so many people came back, anatomy couldn’t be as bad as I feared.” TAs are successful examples that our first-year students strive to emulate. They are positive “Big Sibs.” Our TAs also serve a valuable role in assisting us in remediating students. After initial meetings with the course director, students experiencing difficulty are assigned to TAs. Those in jeopardy of failure are assigned to our Senior TAs. The role of our TAs in this regard has been most successful and has been an important factor in enabling some of our students to pass the course. An additional role of all the second- Figures 6. Important advances in imaging are new and powerful teaching tools. Computed tomographic images (such as this thorax image) are standard in most anatomy courses. SPECIAL ARTICLE THE ANATOMICAL RECORD (NEW ANAT.) 87 UPWARD AND ONWARD Figure 7. Our students are introduced to new technologies, such as the three-dimensional image of the paranasal sinuses of one of our anatomy faculty members (image courtesy of Dr. S. Márquez). year TAs is that they present our largescale examination reviews. These presentations are an intensive and extensive series of area reviews and practice practicals. Their performance in these is monitored by the course director and is part of the TAs assessment. These reviews are greatly appreciated by the class and afford a different level of interaction from that of faculty run sessions. TAs serve an important role in the planning for the next year’s course. They are, by definition, a group of positive and concerned colleagues-to-be whose feedback is honest and constructively given. This coming year, for example, we will be redoing the anatomy guide we give to the students as a combined effort of the TAs and faculty, rather than as instructions solely from faculty as in prior years. They see things we cannot, and thus their eyes will enable us to see further than ours can. Lastly, but of great importance, is the role our TAs have as school-wide ambassadors for anatomy. At any one time in our school, there are at least 45 TAs (current and former) plus additional residents and faculty who have been TAs. Our TAs serve on many student body and school committees and have been wonderful, positive, and powerful advocates. Teachers of anatomy are in the privileged position of being at the forefront of the revolution in visualization. We are, at the same time, learning to walk with a new generation of bright students, albeit a bit different from us and those of our generation. These are opportunities and challenges, which may seem daunting, but at the same time offer great rewards. We have learned many lessons from our experiences at Mount Sinai. Among them is that, if you build a strong, positive team of anatomists, clinicians, and TAs, you will present your subject and course from a position of strength. The value of anatomy should need no explanation—yet in the budget-conscious environments we all live in, everything is under the microscope. Anatomists can only advocate so far for their “vested” interests. Clinical faculty, particularly of senior clout, can often speak with great and potent force. Indeed, to be maximally successful, anatomy programs cannot hide in isolation, but must be at the forefront of integration of material and a home for interdisciplinary teaching and learning. ACKNOWLEDGMENTS Success in our institutional anatomy programs is due to the hard work of our faculty, teaching fellows, teaching Figure 8. Anatomy is a “family affair.” Teaching Assistant J. Mueller (right) is watched by a special guest— his grandfather, Mr. C. Mueller (center) of Mount Sinai’s Board of Trustees. 88 THE ANATOMICAL RECORD (NEW ANAT.) assistants, and staff. Special appreciation is due to other members of our core faculty: Drs. M. Levitan, K. Mak, S. Márquez, and M. McGinnis; the many clinical anatomy faculty, particularly: Drs. A. Bender, G. Chubak, S. Dikman, E. Flatow, D. Friedland, M. Gagner, P. Gannon, H. Gilbert, K. Hague, M. Harris, M. Hausman, D. Herron, L. Hollier, S. Kaiser, N. Kheck, A. Kirschenbaum, M. Klein, M. Klion, I. Kreel, W. Lawson, P. Lento, R. Litwak, G. Mannor, S. Moore, J. Moshirpur, T. Naidich, M. Padilla, N. Perin, M. Poon, L. Raacke, J. Rabinowitz, C. Rosendorff, B. Salky, M. Schaffler, A. Schiller, L. So- bel, P. Som, R. Steinhagen, L. Stone, M. Swartz, A.G. Thomas, M. Urken, and P. Woo; and our former and current teaching assistants. We are also greatly appreciative for the efforts of the staff of the Center for Anatomy and Functional Morphology: Ms. M. Woodson (administrator), Ms. B. O’Donnell, and Ms. P. Moore-Akonnor; and our hardworking faculty and staff of the Department of Medical Education: Dr. P. McArdle, Mr. J. Tedeschi, Mr. S. Yuen, and Mr. H. Supoyo; Mr. G. Puglisi and his crew in the Department of Telemedicine; and Mr. F. Miranda in Audio-Visual Services. Our anatomy educational pro- SPECIAL ARTICLE grams would not be possible without the heartfelt support of our Dean for Medical Education, Dr. L. Smith. LITERATURE CITED Drake RL. 1998. Anatomy education in a changing medical curriculum. Anat Rec (New Anat) 253:28 –31. Haines DE, Hutchins JB, Lynch JC. 2002. Medical neurobiology: Do we teach neurobiology in a format that is relevant to the clinical setting? Anat Rec (New Anat) 269:99 –106. Heidger PM, Dee F, Consoer D, Leaven T, Kreiter C. 2002. An integrated approach to teaching and testing in histology with real and virtual imaging. Anat Rec (New Anat) 269:107–112.