Until 1996, the anatomy course taught to the occupational therapy (OT) and physical therapy (PT) students at the Medical University of South Carolina (MUSC) was a standard gross anatomy course. It consisted of live lectures supported by printed texts with black and white/color drawings and pictures, the use of plastic models, and required dissection laboratories. Due to changes taking place at the national level in the field of rehabilitation (i.e., a shifting of the educational model from a bachelor's degree to a master's degree), and due to the shortage and increased demand for graduates in these fields, the decision was made that year to transform the bachelor's degree to a Master of Sciences in Rehabilitation degree and to add a third group of students (Communication Sciences and Disorders or CSD). Finally, an extension of the PT program was created in Greenville, SC, four hours away from the Charleston campus. The faculty members teaching the course were provided with a two-way compressed video system between the two campuses, allowing the synchronous presentations of slides to both Charleston and Greenville. However, they were also confronted with the impossibility of having a dissection lab on the satellite campus (due to lack of space and qualified anatomy faculty, as well as insufficient financial resources).
In order to compensate for the absence of a dissection lab, the faculty proposed using computer-assisted instruction (CAI) to support the course's educational objectives. A thorough review of the literature clearly indicated that the inclusion of CAI in an anatomy course did not negatively impact the student learning process (Jones, Olafson, & Sutin, 1978; Kulik & Kulik, 1987; Guy & Frisby, 1992), but in fact permitted the acquisition of the course objectives in a reduced amount of time (Jones et al., 1978; Meals & Kabol, 1986; Standford et al., 1994). Keeping in mind that the students enrolling in this Master of Sciences curriculum would never perform any surgery on their patients, the anatomy faculty in Charleston decided to purchase human anatomy software (on CDs) from Gold Standard Multimedia, and to redesign the course without cadaver dissection, instead emphasizing the surface anatomy component of gross anatomy. The first class accepted in the Master of Rehabilitation Sciences curriculum underwent the initial distance education (DE) anatomy course using the two-way compressed video system and the human anatomy CDs in the summer of 1997.
In this article I describe the temporal delivery sequence of an online course combining a course management system's educational tools (WebCT) with locally customized resources. The carefully planned sequence allowed the faculty to meet the educational objectives of the course despite the challenges presented. In outlining the successful adaptation of these resources in a gross anatomy course, I will illustrate their flexibility and convenience for use in other educational contexts.
After teaching the course that summer (1997), we identified several problems that needed addressing:
- difficulties in distributing the lecture notes (five to six pages of notes for each of the 50 hours in gross anatomy, 10 hours in embryology, and 10 hours in surface anatomy) in a timely manner to the 131 students (15 CSD, 39 OT, and 52 PT students in Charleston; 25 PT students in Greenville) on the two campuses;
- difficulties in answering questions during class time due to the time limitations imposed by the compressed video system (exactly 50 minutes per lecture with no possibility of extra time at the end);
- difficulties in simultaneously proctoring written and practical exams on the local and remote sites, as well as difficulties in correcting exams in a timely manner, due both to the distance (4 hour drive) and the number of students; and
- difficulties in using the digital resources available at the time in an efficient and organized manner. These digital resources were either the human anatomy CDs or online resources that started to become available on the Internet at that time (including the Visible Human Project with 3D reconstructions of anatomical structures).
In addition, student evaluations indicated that the students in Greenville felt that they were not benefiting as much as the Charleston students from the surface anatomy hands-on laboratory component, due to the fact that instructors teaching that component were based full-time in Charleston.
By 1997, the Internet had started to revolutionize the world of education, and we wanted to take advantage of this tool in our gross anatomy course. Our first page focused on the knee, which we described in a publication later that year (Bacro, Murphy, & Reeves, 1997). This online experience allowed us not only to understand how the Internet could help solve our difficulties, but also to fully appreciate the efforts required for delivering lectures online. Fortunately, in 1997, MUSC became a beta testing site for a course management system (CMS) company, WebCT, and by the summer of 1998, we were using this CMS to integrate our digital resources and to support the learning objectives in our human anatomy course (Bacro, Coble, Johnson, Trusk, & Ogilvie, 1998). The following three years saw our human anatomy online program through three successive waves of improvements.
During the first year, all lectures were made available online using Netscape Composer. Each gross anatomy lecture was appropriately illustrated with links available on the Internet as well as to the online version of Human Anatomy that had then been purchased from Goldstandard Multimedia (with the CDs still available as backup). All gross anatomy lectures were recorded on videotapes, copied, and made available to all students on both the local and the distant campuses. Only surface anatomy lectures, embryology, and live reviews continued to be taught using two-way compressed videos (T1 line or satellite). Case studies were also developed and posted before written exams to introduce the concept of clinical thinking to the students. Questions related to the case studies were asked during the written exams and answers were posted on the Web site following these exams. In terms of communications, the bulletin board was extensively used in an asynchronous mode to permanently post information related to the lectures and laboratories. Communications were further improved by the use of e-mail to answer questions, with the answer to any student's question beamed to the class at large. Such a range of online resources (Exhibit 1) allowed for the effective delivery of course content; in the evaluation (Exhibit 2), students particularly indicated the usefulness of the videos and video clips.
Over the following two years, the focus shifted to the effective delivery of all exams, written and practical, using the course management system. First, written exams (Exhibit 3) were successfully delivered through the system, with the practical exams being delivered as in the past. The following year, Adobe Photoshop was used to prepare the images for the online practical exams (Exhibit 4), which allowed arrows to be positioned on pictures of anatomical structures, perfectly mimicking the practical exams. All online exams were proctored on each campus with the access controlled by password. Release of grades and feedback was organized in a timely manner in the days following the exams, allowing students to check their answers. Evaluations of the course by students indicated that the online delivery of both written and practical exams was positively perceived by the students (Exhibit 5).
Concomitantly to the creation of online exams, an entirely new set of resources was created to support the surface anatomy component of the course. These students are trained to become clinicians who will use palpation as a diagnostic and therapeutic tool. However, digital resources were not available at the time to support this educational goal. To address these issues as well as the concerns of the Greenville students, online lectures were written to define all the clinically important structures that these students had to know. Pictures (.jpg) and RealPlayer videos were created to illustrate these anatomical structures and linked to the definitions listed in the online lectures loaded in our CSM. The videos were delivered through the MUSC streaming server when viewed within the university system in Greenville or Charleston. They were also made available through CDs. Due to the low level of electronic education of our students at the time, coding was developed that allowed the students to view the videos on the CD in combination with the WebCT lectures, without having to go through the somewhat cumbersome process recommended by WebCT at the time (Bacro, Gilbertson, & Coultas, 2000). A demo of this process is available online.
Following this initial success, the decision was made to address an important issue in the field of anatomical sciences. A consistent criticism from traditional anatomy instructors as well as students is that the images provided in digital format or in textbooks do not provide for the three-dimensional nature of anatomical structures when viewed in a cadaver laboratory. Using the process that had been developed for the surface anatomy videos, an online database of video clips of gross anatomy structures (cadaver dissections), Anatomy on the Web, was created and linked to our WebCT course. For example, click here for a gross anatomy clip illustrating the facial nerve (to view this clip you will need RealPlayer; for a free download, click here). This work is currently in progress, with more than 400 videos already loaded to illustrate the human anatomy online course.
This now fully developed online human anatomy course will continue to be taught in the Department of Rehabilitation Sciences at MUSC. Meanwhile, other institutions have also integrated computer-assisted instruction (CAI) in their curriculum (Mattingly & Barnes, 1994; Fitzharris, 1998), with the CAI software being locally created or purchased commercially (Jones et al., 1978; Meals & Kabo, 1986; Walsh & Bohn, 1990; Standford et al., 1994). The approach of using computers to successfully support an anatomy course is therefore not unique to MUSC. However, this is the first time to our knowledge that a CMS (WebCT) has been used to integrate the digital resources required to teach an anatomy course, including new streaming video clips, online exams, and communications tools.
[Editor's note: This paper is modified from a presentation at the 2001 WebCT conference in Vancouver.]
Bacro, T., Murphy J., & Reeves, B. (1997). An internet review of the anatomy of the knee joint. Journal of Allied Health, 26 (4), 159-161.
Bacro, T. R. H., Coble, W. L., Jr., Johnson, D. D., Trusk, T. C., & Ogilvie, R. W. (1998). Use of interactive technology in teaching anatomy to physical therapy students: effectiveness and students perceptions. Physical Therapy Journal, 78 (5), S9.
Bacro, T., Gilbertson, B., & Coultas, J. (2000). Web delivery of anatomy video clips using a CD-ROM. New Anatomist, 261, 78-82.
Fitzharris, T. P. (1998). Survey of gross anatomy courses in the United States and Canada. The Anatomical Record, 253, 162-166.
Guy, J. F., & Frisby, A. (1992). Using interactive videodiscs to teach gross anatomy to undergraduates at Ohio State University. Academic Medicine, 67 (2), 132-133.
Jones, N. A., Olafson, R. P., & Sutin, J. (1978). Evaluation of a gross anatomy program without dissection. Journal of Medical Education, 53, 198-205.
Kulik, J. A., & Kulik C. L. C. (1987). Review of recent research literature on computer-based instruction. Contemporary Educational Psychology, 12, 222-230.
Mattingly, G. E., & Barnes, C. E. (1994). Teaching human anatomy in physical therapy education in the United States: A survey. Physical Therapy, 74, 720-727.
Meals, R.A., & Kabo, J. M. (1986). Computerized anatomy instruction. Computers in Plastic Surgery, 13, 379-387.
Standford, W., Erknonen, W. E., Cassell, B. D., Moran, G., Easley, R. L., Carris, & Albanese, M. A. (1994). Evaluation of a computer-based program for teaching cardiac anatomy. Investigative Radiology, 29, 248-252.
Walsh, R. J., & Bohn, R. C. (1990). Computer-assisted instruction: A role in teaching human gross anatomy. Medical Education, 24, 499-506.management gamesmahjongbrick bustercard gamesaction gamespc gamessimulation gamesdownloadable games