Table Of ContentA New Approach
to Teaching
and Learning Anatomy
Objectives and Learning Activities
Michael J. Blunt, MB BS, PhD, FRACS (Hon)
Chai I is Professor of Anatomy,
The University of Sydney.
Staff Associate, Regional Teacher Training Centre for
Health Personnel, The University of New South Wales
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First pubUshed 1976
ISBN 0 407 00098 4
© Butterworth & Co. (Publishers) Ltd 1976
Library of Congress Cataloging in Publication Data
Blunt, Michael J
A new approach to teaching and learning anatomy: objectives and
learning activities
Bibliography: p.
1. Anatomy, Human-Study and teaching (Higher)
L Title. [DNLM:1. Anatomy-Education. QS18 B659nl
QM30.B55 6ir.007'll 75-23311
ISBN 0407-000984
Printed in England by Chapel River Press, Andover Hants.
Foreword
It has been for long an unshakeable tenet of medical education that
its foundations require a strong element of human anatomy, but just
how much, relative to other demanding disciplines, and in what form,
has been increasingly subject to questioning and debate. Among medical
students, topographical anatomy has not been a favourite subject. At
best, it has too often seemed a mass of facts ill-related to each other or
to anything else, another bulwark severely guarding the path to clinical
work, a test of unquestioning perseverance used to weed out the lazy
and insufficiently committed. At worst, it was a distasteful subject,
based largely on personal experience of dissecting the corpse. The
beauties of the body-forms, contours, proportions-had commonly
been ravaged by age, and preservatives had homogenized the varieties
of texture and colour of living tissues, and blurred the challenging
intricacies of their exquisite relationships. The task offered little enjoy
ment, either sensual or intellectual, to condone the sacrilege of tampering
with the dead.
Professor Blunt's system abjures this soulless drudgery of striving
after the 'unsupported acquisition of morphological data'. He offers
a series of integrated modules of study, in which the input of informa
tion by lecture, film, reading, etc. is closely Hnked with opportunities
to reify it by investigating three-dimensional material—prosections,
skeletal parts, models, the living body. This is done in collaboration
between 4 or 5 students. The findings of 3 or 4 of these groups com
bined may be checked, reinforced and clarified in discussion under
leadership of their tutor. A more wide ranging, problem-solving
oriented approach is also adopted in groups in which associative interac
tion among students is encouraged. And, at intervals, the student
evaluates his progress with self-marked multiple choice questions.
VÜ
Professor Blunt's well-tested recipes are meticulously selectea,
organized and described, but he offers them tentatively, reiterating
their potentialities for flexibility, permitting various modes of inte
gration with other parts of the course. Confidence is inspired by his
masterly discussion of goals, general objectives and specific objec
tives, and his discriminating use of varieties of learning media-espe-
cially his imaginative arrangements for different kinds of group work.
The great power of the system, as I see it, is that it is underpinned by
rigorous evaluation of two major trends in present thinking about
higher education. One is the acceptance of the need to plan and
organize the content of the course in terms of clearly stated objectives
which students can understand and undertake. The other is commit
ment to the recognition of the student as an active participant, thriving
less well on forced feeding than used to be thought, and needing
support to learn how to learn by interacting with his peers as well as
with his teachers.
M. L. J. Abercrombie
2 Bridge Lane,
Little Shelford,
Cambridge.
vm
Introduction
The design of new curricula in medical schools usually involves a
problem of providing detailed syllabi or sets of informational objectives,
and often, new class schedules or new textbooks to 'back up' the more
restricted content of the new teaching. In this book the approach has
been to provide sets of general instructional and specific behavioural
objectives to define the framework of a course in Human Anatomy.
The latter indicate learning outcomes in terms of the observable per
formances of students, and since they show both staff and students
what students will do with their knowledge, what they will identify,
observe, indicate, interpret, deduce and so on, the behavioural objec
tives impHcitly set out the depth of knowledge necessary to perform
in such ways. They outline a core of knowledge in topographical and
neurological anatomy arrived at by consensus of opinion of the
anatomy staffs and some students at the medical schools of the Uni
versity of New South Wales and the University of Sydney. Several
clinical colleagues have also given advice. It is hoped that the same
objectives will prove generally useful as a guide to study in other
anatomy courses. Just as no textbook is ideally suited to the needs
of many different courses it would be too much to expect that this set
of objectives would meet with anything approaching general acceptance
precisely as they stand. The objectives, however, are far more flexible
than textbooks designed around specific courses; they lend themselves
readily to modification, whether by expansion, addition or deletion
whilst at the same time providing a base Une from which such oper
ations may be conducted. They also readily lend themselves to either
horizontal or vertical integration with teaching in other subjects. It is
therefore envisaged that they may be widely useful to those who are
engaged in teaching-learning programmes in anatomy whether as
medical educators or as students.
ix
The objectives are preceded by explanatory notes which deal with
the principles and the techniques involved in their formulation so that
their expansion or modification may be facilitated. Methods of using
the objectives as guides to study are also suggested.
In the programmes in which the objectives have been employed their
use has been combined with learning activities designed to foster educa
tional group discussion, a procedure in which all the members of a
group, teacher and students alike, accept involvement in and responsi
bility for the teaching-learning process. The brief description of the
aims and techniques of this type of teaching—learning programme may
be helpful to teachers of anatomy and to students in those departments
where comparable methods are adopted.
This outline of aims and techniques of small group teaching in
anatomy relates to sets of suggested learning activities closely linked
with the objectives which form the basis of the teaching—learning
programme. Like the objectives they are intended as a flexible frame
work. Their effective use depends upon provision of sets of prosected
specimens, and directions for the preparation of such specimens are
included in an appendix.
The objectives may be used either in conjunction with the suggested
sets of learning activities or quite independently. If used independently
they may be coupled, either with programmes in which dissection is
undertaken by students, or in those in which use is made of pre-
dissected specimens and other prepared teaching materials. They may
form a framework for lecture or tutorial teaching or be used simply as
a guide signposting appropriate emphasis for private study. Most of
the information necessary to achieve the objectives may be obtained
from a variety of standard anatomical textbooks.
The learning activities described were originally intended for a
course in topographical anatomy and neuroanatomy occupying
approximately 220 hours of formally allocated teaching time. They
were designed around the use of prepared specimens and other teaching
aids and the relevant staff/student ratio was 1 to 15. The same
teaching—learning programme has been, as an interim measure, success
fully modified and incorporated as part of a more extensive course in
which dissection of the whole body was carried out by students and
450 formally allocated hours were available for instruction. In the
latter case prosected specimens were made available for small group
learning activities selected from those that have been Hsted; the staff/
student ratio was 1 to 19. In both instances the course could have been
greatly improved by a better staff/student ratio but the results were
nonetheless satisfactory. It is frequently asserted that effective small
group teaching necessitates staff/student ratios more advantageous than
those commonly encountered within departments of anatomy. In both
the courses referred to, however, short-term performance outcomes
considerably exceeded staff expectations on the basis of previous
experience in more traditionally orientated courses. Attitudinal out
comes were such that in the first course described more than 80 per
cent of students assessed the programme as the most effective
teaching-learning experience they had thus far encountered, and as
highly effective in stimulating interest in the subject matter (Blunt
and Blizard, 1973). When selected learning activities were incorporated
into the modified course in which students dissected the whole body,
the comparable response dropped to 70 per cent. It is suggested that
the total course outline presented, incorporating all the learning activ
ities listed, is best suited to a course of about 300 hours duration with
a staff/student ratio (effective full-time staff/effective full-time stu
dents) of at least 1 to 10.
I should like to express my indebtedness to many present and
former members of the staffs of the School of Anatomy in the Univer
sity of New South Wales and the Department of Anatomy in the Uni
versity of Sydney who have assisted with material forming parts of
this book. Those to whom I am most indebted for initial formulations
of specific behavioural objectives and suggested learning activities are
Drs D. Fernando, E. Tedder, D. Utley, CR. Watson and Mrs. A.
Glucina, but there has been much subsequent modification in use and a
large number of individuals have been involved in this.
I should also like to thank my secretary, Miss Maria Karlsson-Lillas
for many helpful suggestions and for typing the manuscript.
Michael J. Blunt.
XI
Chapter 1
Goals
Most university teachers in faculties of medicine would be affronted
by the suggestion that they are not aware of the objectives of the
courses in which they provide instruction, at least in a general sense;
there is also a rather general assumption that course objectives are
adequately indicated by the units of instruction conveyed by lectures
or contained in recommended texts. Yet it is still relatively seldom
that even general objectives are committed to paper, and a confusion
of purposes is evident if lectures and texts which should facilitate the
learning process are also used to indicate what is relevant, 'core', or
examinable material. Unfortunate secondary effects of reliance on
direct teaching situations to imply course objectives are that teaching
is not planned in accordance with predetermined objectives, the objec
tives implied may not be achievable by a majority of students, and, in
any event, all that is actually conveyed is a set of objectives for the
teacher and not for the individuals at whom the teaching is directed.
Clearly a great deal of work is involved in first specifying objectives
and then building a course, possibly involving a variety of teaching
techniques, around them, but it would at least be widely conceded that
this is a logical approach to course planning. Perhaps the major question
that arises is: Is the improvement that might result likely to be com
mensurate with the effort involved? Much then depends upon the
clarity and specificity with which the objectives are formulated and on
their achievability by students taking the courses.
The first essential would seem to be the formulation of overall
general objectives or Goals for the whole course. Necessarily they
will encompass consideration of the broad concepts and principles to
be inculcated and the skills, and possibly even the attitudes, to be
taught and acquired. Such goals might be expressed in terms of either
2 GOALS
teacher performance or hoped-for student outcomes, two aspects of
the teaching-learning process which may or may not turn out to be
causally related. By and large it will be better if general outcomes are
designated in terms of student performance rather than teacher aspira
tion since the former is likely to be more assessable and more directly
useful.
The Goals adopted for the course framework to be described were
as follows:
The student effectively uses anatomical knowledge:
(a) as a basis for study of other prechnical and clinical subjects and
to correlate morphological with functional data in the study of the
human organism;
(b) as part of the basis for the study and the diagnosis of common
clinical conditions;
(c) as part of the basis for problem-solving in relation to both
normal and disordered function;
(d) in the development of communication and observational skills.
It will be evident that these goals, though very generally expressed,
exclude the unsupported acquisition of moφhological data. They also
exclude the study of anatomy in relation to surgical treatment. These
areas of knowledge are appropriate, respectively, for the anatomist
and surgeon in training. Neither is considered to have a proper place
in a generalist undergraduate teaching programme. Also no mention is
made of the ubiquitously expressed aim to give the student training in
scientific methodology or philosophies. This exclusion is deliberate
and is made not by any means because such aims are rejected, for it
is clear that, up to a point, they will be automatically achieved in the
teaching of any science subject, and, if the teaching-learning process
is an active one resting heavily on inference and deduction, there is no
particular need for specific designation of such methodological aims.
Moreover, when those aims are specifically identified they frequently,
if not usually, become the excuse for broadening the content of pre
chnical courses beyond areas of general relevance to the medical stu
dent, and, since this phenomenon is met with in one after another
discipline, the result is the medical course overloaded in factual content
that is the common experience of educators and students. Whereas
methodological aims are an entirely proper part of elective courses,
they easily become disastrous when reiterated in all the subjects of the
undergraduate curriculum.
Chapter 2
General Objectives
Having decided on broad goals, the next step is to decide on General
Objectives that will indicate course content and the sequence of
learning. It sounds a fairly simple matter to state generally the learning
outcomes expected of a course, but, in fact, there are some difficulties.
There is a tendency to concentrate on the processes of teaching or
learning rather than on the expected outcomes of the learning. There
may also be a problem in finding the appropriate level of generality:
in other words it may be difficult to strike abalance between statements
so broad as to be effectively non-selective and long Usts that indicate an
exhausting variety of specific behaviours. The easiest way to effect the
appropriate compromise is to link each general objective with a list of
specific behavioural statements which amplify and quaHfy the general
objective and at the same time provide samples of the sorts of outcomes
that will serve as evidence of its attainment. A very useful, brief guide
to the writing of both general objectives and specific behavioural
objectives has been provided by Gronlund (1970). In most instances it
will be convenient to list general objectives first and then to provide a
series of exemplary specific behavioural objectives, but at other times it
is advantageous to reverse this process. In illustration a general objective
and specific behavioural objectives forming part of a topic dealing with
masticatory processes and taste are set out as follows:-
General Objective
Comprehends the disposition, functions and group innervation of the
masticatory muscles.
