Clinical Anatomy and Imaging Lab: Vertical Integration in a Preclinical Cardiovascular Course
Authors: Hankin Mark , Downs Emily , Barry Deborah , Malik Nitin , Moak James , Soukoulis Victor , Dent John 
Published: November 2023

BACKGROUND

Gross anatomy at the University of Virginia School of Medicine is presented within organ systems courses. Active dissection is used in two courses (Musculoskeletal and GI). In others, including Cardiovascular, anatomy is experienced in a single lab session in which students examine prosections, plastic models, and anatomy software (VH Dissector and A&P Revealed). To enhance this initial experience, the anatomists and clinical faculty created a second lab ‐ the Clinical Anatomy and Imaging Lab (CAIL) ‐ that would allow students to scaffold their foundational knowledge by placing it in a clinical context. The CAIL was placed near final exams to reinforce anatomy from the initial lab and to vertically integrate with clinical presentations in the course.

THE NEW LAB

The CAIL followed a single patient undergoing evaluation and treatment, and included five stations: (1) Echocardiography: an auscultated murmur prompted evaluation for valve disease with a finding of severe aortic stenosis – students practiced cardiac ultrasound on live models; (2) Cardiac catheterization: coronary artery disease was evaluated before operative intervention – students explored anatomy related to catheter placement; (3) Surgical aortic valve replacement: open aortic valve replacement (with median sternotomy and a pericardial well) simulated using a Sikon Soft‐Cured cadaver, a modified Thiel method (see 2016 AAA abstract Heltzel et al.) – students reviewed relevant cardiac and thoracic anatomy in the context of a surgical field; (4) Cardiac tamponade and pericardiocentesis: during recovery from surgery, the patient experiences dyspnea and is diagnosed with a pericardial effusion – students reviewed the pericardium and practiced pericardiocentesis using a simulator; and (5) Cardiac trauma: the patient is involved in a motor vehicle accident after his surgery and undergoes trauma evaluation – students reviewed structures susceptible to cardiac trauma and discussed proper steps in evaluating a trauma patient, with focus on injury of the heart and great vessels. Teams of clinical and basic science faculty guided each lab station.

RESULTS & CONCLUSIONS

This CAIL was developed following a lesson study model for educational innovation, which focuses on researching student learning as a method of improving teaching skills. Data from detailed field notes, audio recordings at each station, and student focus groups and faculty debriefings were analyzed qualitatively for themes using an open‐coding technique. Preliminary analysis of focus groups reveals that students believed the labs and lecture material were integrated in a novel way; the CAIL contextualized lecture material with hands‐on experience in a simulated clinical setting. From a faculty perspective, the collaborative development of CAIL was a novel experience that afforded an opportunity for continuous professional development within the multidisciplinary development team. Data will provide a basis for improvement of the cardiovascular CAIL in following years, and provide a model for the development of CAILs in other organ systems courses. This process demonstrated the feasibility of a clinically relevant anatomy lab experience within the preclerkship curriculum.

Support or Funding Information

None