Not Your Father’s Anatomy Class
By Lisa A. Stark
Before the first class is taught, the UNLV School of Medicine (UNLV SOM) will have already notched a lofty achievement: It will be the only medical school in the world to open with an exclusively Virtual Anatomy Lab.
A heady accomplishment when you consider that Las Vegas is not thought of as a global leader in either the healthcare or education space. But times are changing.
“We are creating an innovative curriculum, embracing forward-thinking principles to provide students the foundation needed to succeed over the next 50 years as practicing physicians,” says UNLV SOM Dean Dr. Barbara Atkinson.
One of these forward-thinking principles is to embrace the latest technology, hence the 21st century concept of 3D Anatomy.
“The idea to open as an all-virtual anatomy lab was a no-brainer,” says Dr. Jeff Fahl, UNLV SOM Director of Anatomy and the physician charged with creating the curriculum for the first ever exclusively virtual anatomy course. “Even though virtual anatomy is the future, most medical schools still base their curriculum on Cadaveric Anatomy,” says Fahl. “They may have one or two digital anatomy tables but the focus is on cadavers.”
On the day he is interviewed, Fahl gives DAVID Magazine a quick, impromptu tour of the Shadow Lane campus, which will serve as the medical school space for its first five years. A new building is in the planning stages for the adjacent Medical District.
Fahl proudly shows off the library, breakroom, lecture hall and small classrooms designed for collaborative learning. His excitement is most palpable, however, when we enter the Digital Anatomy Lab.
“This is my fiefdom,” he says with a smile.
When you enter, you see the six giant touchscreen tables which look like super-sized iPads. The tables are in place of cadavers found in a traditional anatomy lab.
UNLV SOM has six tables that cost about $100,000 each. This is a fraction of the $10 million it would cost to build (and the $2 million per year it would take to operate) a traditional cadaveric anatomy lab.
In Fahl’s opinion, a digital anatomy lab is not only less expensive but more efficient.
“In medical school, I spent about 260 hours dissecting cadavers,” he says. “Most of what I learned then I have long since forgotten. As a practicing physician for 35 years, my world consists of looking at CT scans, MRI’s, ultrasounds, and X-rays.”
Fahl asserts that Digital Anatomy leads to a better understanding of Radiological Anatomy. Hence, it prepares most doctors for the real-life patient cases they will encounter.
The tables are impressive, engaging tools. It is hard not to get sucked in by the vast universe of anatomic knowledge immediately accessible with the touch of a screen. “These are slides of an appendix at the cellular level,” Fahl says as he demonstrates how the tables work. With a squeeze of the screen he zooms in to focus at a deeper level allowing one to see the nucleus of a cell. On this slide, one can see the orderly make up of cells, but also those areas where the cells are disordered, which represents a cancerous tumor.
The power of the table lies in how a CT scan or an MRI turns into a 3D rendering. With the touch of a button one can dissect an image and look inside to vividly see tissues, muscles, bones and cells. And then put it back together again. One can see how the human body is “perfectly ordered” according to Fahl. This makes it easier for the medical student to learn form and function, the two pillars of any anatomy course.
Interesting, and a bit creepy, is how these 3D renderings came to be.
In the 1990s the National Library of Medicine’s Visible Human Project sought donations from a man and a woman to create anatomical, three-dimensional representations. The call for donors was answered by a man in Texas serving time for murder and looking to atone, and a housewife from Maryland. By slicing, scanning, and photographing cross sections of each body we have complete digital models for the students to study.
UNLV SOM students will be able to log in to the digital anatomy tablets from their iPads, which will allow them access 24 hours a day, 365 days a year. In addition to the case studies built into the software, they can input their own.
Despite the advantages of a Digital Anatomy Lab, many still feel there will always be a fundamental need for cadaveric dissection.
Chris Ruff is the director of the Johns Hopkins Center for Functional Anatomy and Evolution. He feels that digital simulation can give you an idea of where things should be, but it’s nearly impossible to get the level of detail that one can see in the flesh. It is a helpful educational tool for reviewing systems after the fact. “But for really learning it and seeing it for the first time, it’s like looking at a movie of someone hiking through the Grand Canyon versus actually hiking through the Grand Canyon” says Ruff.
To meet this need, the UNLV SOM will include cadaveric anatomy for future surgeons included in the their 4th year electives.
“We also will provide opportunities at the Clark County Coroner’s Office for students to learn how a pathologist examines a deceased body,” says Dean Atkinson.
Dr. Fahl is currently writing the curriculum for the Digital Anatomy course which starts in late November. “The tables give us a channel to teach students anatomy in a way they will use for the rest of their lives,” says Fahl.
Digital Anatomy trickles down to the patient. If a physician has a deeper understanding of not only of what he sees on a CT scan but why and how, then he can better explain a condition or treatment to a patient. And that ultimately leads to better communication, building trust and solidifying the patient-doctor relationship.
Fahl then shares a little secret.
“This is not a true virtual lab,” he says. “it’s more like 3D.” In a virtual lab, you can interact with the 3D images in a real or physical way using special electronic equipment, such as a helmet with a screen inside or gloves fitted with sensors. Unfortunately, an anatomy lab like this does not yet exist. Perhaps this will be a future achievement for the UNLV SOM.
“With everything we have in place, we are capable of moving to a true virtual lab,” says Fahl. “That is the next step.”