Topographical anatomy of limbs

Introduction

The article refers to E-learning courses Topographic anatomy of lower limb and Topographic anatomy of upper limb. They are made in English, in LMS Moodle and they are available on the server of Faculty of Medicine in Hradec Kralove. Mentioned courses are concerned in topographical anatomy. This branch of anatomy does not cope with separate organs, however, it describes their mutual relationships. It is more practical then systematic anatomy and is closer to perception of clinical medicine.

Purpose

Faculty of Medicine in Hradec Kralove is specific for its syllabus of anatomy, which takes only 2 semesters. Unfortunately, time stress makes students to focus on systematic anatomy and to sidetrack the topographical anatomy. For this reason the courses aspire to complete current contents of practical classes suitably and to clear blind spots not only in syllabi, but also in motivation of students.

We decided to compose them from own texts and remarks, authorized pictures and photos of our dissection specimens. Authorial approach should guarantee an absence of any extraneous copyrighted materials. Unfortunately, this condition is not automatically kept nowadays in the time of scanners because number of similar Internet sources does not observe this base.

Two years ago, our ambition was to create an Internet course of the topographic anatomy available to all students of medical faculties. At the same time, a similarly oriented Internet atlas was created by students of Palacky University in Olomouc as well. Their study material was based on photographs of delicate dissection work as it is a good tradition in Olomouc’s anatomy, but unfortunately it was small personal and friendly in its first version, with no feedback. This fact stimulated us to create real E-learning course in accordance with standards of modern education, not only copied chapters of any textbook.

First, our courses were equipped by feedback from the same beginning. Feedback components are built not only for students but also for the creators, so the courses can be improved and completed continuously. Students need to confirm after their study of any lesson whether they understood the topic and they are ready to continue by following lesson. For this purpose, each lesson should be concluded by a quiz. Such quiz may not be in form of an official evaluation at any cost but it should handle valid information about level of student’s learning. On the other hand, the author of a course has a feedback from questionnaires or discussion forums which can be or generalized or aimed to any specific problem of studies by appropriate question.

We started by a pre-version of Czech course, but we decided to give a priority to English version. Such special care for foreign students studying in English language had a task to integrate various foreign sources and to offer help to students situated in outland.

The materials are aimed to the undergraduate study of General Medicine, but they may serve for study programs of Dentistry or Physiotherapy as well. The courses are opened not only for students of the 1st year studying the anatomy by their schedule but also for students of highest years to remind topographic relations in various regions of the body. Present list of the visitors acknowledges this assumption. Moreover, target group is not restricted only to students of our faculty, because the publishing in the network Mefanet may extend it to populous group of potential visitors.

Solution

Specific way of our solutions results from consequent procedure. The first step is a diligent dissection of selected region of the human body, occasionally adjustment of older dissection specimens followed by photography and drawing. After data capturing there is the time for work with graphic editors or video studio in case of video files. The other used software includes html editors and text editors. The records are then loaded into modules of LMS Moodle or they are made in Moodle directly on-line (quizzes, questionnaires).

All mentioned courses are subdivided to several lessons. In all cases, the first lesson explains the principles of the topographical anatomy in general, because we believe that this question is principal. It makes the students to distinguish the topographical anatomy and the systematic anatomy, to impress the plan of description of regions. Following lessons are divided just by the regions of human body. They are arranged from proximal part of a limb to distal parts, however they allow to be studied on demand. The regions named in the final examination questions were preferred at first. Each lesson is started out by brief text explaining separate sources and their significance. We make effort to use not academic phrases but language familiar to students both in Czech and in English versions.

We use these components offered by Moodle:

1. Uploaded PowerPoint presentation as principal source containing described photos, illustrations, and supporting text. We preferred this form for advantage of off-line creation.
2. Document of Microsoft Word is more continual and complete text source in comparison with the first type of material. All texts are original works of the author based on knowledge of literature and also experiences from own dissection works, that is why they may differ from some commonplaces known from textbooks. The texts are clearly structured by bullets, anatomic terms are highlighted. Document to each lesson is in extent of 2-3 A4 pages and it fits to be printed.
3. Video files in mpg format should bring demonstration of dissected specimens. They can be created by editing of older records and post-dubbed. The duration takes several minutes. These videos are currently loaded only into two lessons, however their creation comes up.
4. Interactive pictures come from authorial illustrations by covering with interactive zones in html editor. When the cursor is over any osseous structure, a title with anatomic name appears on screen while the other structures (muscles, vessels, etc.) have to be answered. Their correct name appears in upper frame of the window after clicking. So this material can serve both to study and to examination. The interactive pictures are made in well-tried program FrontPage as integral part of the courses and they are loaded into Moodle in form of links to html pages.
5. Quizzes are built to represent and evaluate level of acquirements of a student. After the student finished the test, a verbal grade allows him to continue to another lesson or it recommends him to turn back to study materials of the not-mastered lesson. Quizzes in Moodle offer several types of questions and many other supplements and preferences, for example time limit, responses to bad answers, possibility of the repeated answer with a penalty factor, number of attempts and others. As for the types of questions, we use mainly the multiple choices and matching, less commonly other types like correct short answer or true/false. Moreover, Moodle allows sending the results of tests under the name of a student to the teacher. These results can become a ground for classification, even to credit. However, if the evaluated students are not gathered in one room equipped with sufficient number of computers and a necessary inspection, the validity is dispute. Then it is not possible to guarantee that the quiz is answered by logged students and not by collection of helpers. This is the limit of using E-learning and each creator can decide whether a credit can run in such symbolic way. We will not concede official evaluation of results by Moodle, but we will let the results as an individual feedback. It is for the reasons described above and also to keep the voluntariness.
6. In a questionnaire we ask either about matters concerning a content of the course, e.g. difficulty or priority of selected sources or about situations concerning accessing to a course, e.g. which part of the semester evoked the need to enter a course.
7. Discussion forum, as was mentioned above, can be either opened to all remarks or aimed to the content or processing of the course. We use this component for both purposes, moreover the former case may be used just to contact a teacher.
8. The book and the glossary are the names of modules using reciprocal interaction. They represent the last components added to our courses. For the forced graphic solution of “the book” we currently prefer to use simple html pages made just in Moodle. These pages interact with the glossary contrary to loaded documents in MS Word. The glossary contains a list of anatomic terms with a description of about 3 sentences. Each term loaded in the glossary is automatically highlighted if it is found in Moodle pages.

Conclusion

In conclusion, we effort to create a quality source of information but it does not mean that we plan to replace regular education in practical classes. The study of anatomy belongs into dissection rooms seriously. We would like to enable students to repeat the contents of classes after education or to prepare better for following classes in comfort of computer rooms. Of course, these courses can be very useful for the time of vacation when is not possible to study in the dissection rooms for incomplete staffing. Moreover, the courses motivate the students and offer them to cooperate on the education by participation on feedback.

Courses enable to log as "guest".

Link		Date	Availability [?]	Clinically sensitive [?]	Licence
Topographical anatomy of the upper limb		12.3.2016	access controlled with external service	–
Topographical anatomy of the lower limb		12.3.2016	access controlled with external service	–

4-D assessment:

Textbooks and manuals	Educational websites and atlases	Digital video	Presentations and animations	Casuistics in images	E-learning courses (LMS)	Reviewed information × Information about review process Guarantee prof. MUDr. Aleš Ryška, Ph.D. Fingerlandův ústav patologie, Lékařská Fakulta UK Hradec Králové phone: +420 495 833 748 e-mail: ryskaale(at)fnhk.cz Reviewer Assoc. Prof. David Kachlík, MD, PhD Ústav anatomie, 3. lékařská fakulta UK phone: 12345 e-mail: david.kachlik(at)lf3.cuni.cz
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