Gross anatomy: What’s a first-year medical student to do?

An excerpt from So You Got Into Medical School… Now What?: A Guide to Preparing for the Next Four Years.

By far one of the most unique experiences first-year medical students can have is working in the gross anatomy lab. From the potent smell of formaldehyde to the chill of the ventilation, the anatomy lab provides a visceral experience that is hard to forget. The thought that the cadavers on display were once living beings and are now about to be dissected can overwhelm even the most stoic student. Human anatomy is hard enough to learn when displayed neatly in a book, but combining it with a cadaver can unsettle anyone. What’s a first-year medical student to do? Should she spend every available minute in the lab? Or should she just learn anatomy from a book and hope everything will look the same on the practical examination?

The best way to learn anatomy is using both methods — dissecting cadavers and studying the book. The least efficient way to do this is to simply show up in the anatomy lab unprepared. To avoid wasting time, you need to enter the anatomy lab with a plan. If you don’t know what you’re looking for, you can waste countless hours in the lab looking at pictures and hoping you don’t cut something vital. If you’re already familiar with the anatomy you’re trying to learn, both the dissection and identification will proceed more quickly and smoothly. Learning the anatomy from a neatly displayed and labeled anatomy text takes less time initially than does learning on a messy, unlabeled cadaver. Thus, the most efficient way to approach the anatomy lab is to first learn what the anatomy is supposed to look like by studying textbooks or lecture slides. Once you know what things are supposed to look like, you’ll have an easier time recognizing those parts in the cadaver.

Most medical students usually ask what kind of time they need to spend in the lab. Some students seem to practically sleep there, while others seldom show up. We’ve already established that those who have studied and are familiar with what the anatomy is supposed to look like will spend less time in the lab. But suppose you already know the anatomy reasonably well. How much time should you spend with the cadaver, considering that you will be responsible for knowing a long list of items? Some of these are easy to find (large muscle groups), while others are damn near impossible to find (small nerves). Of course, every cadaver is slightly different, so while one muscle may be hard to find in one cadaver, it could be easy to find in another. For this reason, it’s wise to make every effort to examine a few cadavers. Know that some items are almost impossible to find no matter which body you choose to examine. Many medical students end up spending large amounts of time looking for almost-impossible-to-find structures such as the thoracic duct. The question becomes whether you should spend extra time trying to identify every single structure.

Not surprisingly, the principle of diminishing returns applies here as well. If you wish to find every item on every list, you’ll spend most of your time searching for the harder-to-find items. Think of this as searching for the proverbial needle in a haystack. Suppose you really want to find the ligamentum teres and decide that you won’t leave the lab until you’ve found it. You might end up spending a half hour searching multiple bodies before you finally identify this structure. You need to ask yourself if the discovery of the ligamentum teres is worth half an hour of your time. For those bent on achieving a perfect score, the answer is yes. For most other medical students, the answer is no. If you know the anatomy well, you can assume that the harder an item is for you to find, the harder it is to find for the faculty as well. This doesn’t mean the ligamentum teres, for example, won’t show up on a practical exam; it just means that it has a lower probability of showing up. In my experience, having studied anatomy thoroughly, when I was unable to find an item on an already-dissected cadaver in under a minute, it seldom showed up on the exam.

Daniel R. Paull is a physician and author of So You Got Into Medical School… Now What?: A Guide to Preparing for the Next Four Years.

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