Medicine From The Trenches

Experiences from medical school, residency and beyond.

Mastering Gross Anatomy

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I thought I would write a short essay about my experience with Gross Anatomy class when I was in medical school. This class can cause some angst and turmoil for some freshman medical students because it generally requires the greatest adjustment in terms of study skills and habits.

First of all, Gross Anatomy does not require any great feats of intellectual insight. The material to be mastered takes diligent and systematic study. In short, there is NO substitute for just grinding through the process and taking the time to organize the material for study. At my school, Gross Anatomy also included Embryology which, made Gross Anatomy (GA) far easier to organize in my opinion.

During orientation, we were given a huge syllabus complete with objectives, lecture schedule and lab schedule arranged by topic. We were also given an exam schedule which allowed us to know exactly how much material each exam would cover and when the exams would be given. The breakdown was along the lines of Exam 1 – Extremities and Back Muscles, Exam 2- Thorax, Abdomen and Pelvis, Exam 3 – Head and Neck. This division made sense because dissection and study of the Back Muscles and Extremities requires far less manual precision than dissection of Head and Neck Structures. By the time we reached study of Head and Neck, we were old “pros” at dissection and finding structures.

My best tools for study of Back Muscles and Extremities were my embryology book and one of the skeletons. Our anatomy department had loads of bones and skeletons everywhere in the gross lab. My first approach was to sit down with the syllabus and look over what would be covered in lab and lecture. My next approach was to skim the material in the syllabus looking carefully at the objectives. This usually took less than 15 minutes tops and I was on to the reading making notes in the margins of the text that corresponded to material that was mentioned in the objectives.

My GA textbook was Moore’s Clinical Anatomy for Medical students. I had the binding removed from this book so that I could place the reading pages in a three ring binder. I always had something readily available for reading. My next step was to photocopy or scan the Netter plates that corresponded to the lecture that we would be covering. I would note with a pink highlighter, any structures that were mentioned in the syllabus. That was my prep for each lecture. After hearing the lecture, I would study my notes (or the noteservice notes) and do the same prep for the next lecture.

In prep for lab, I would take out my dissector and make a check sheet of every structure that were expected to observe in lab. I would organize them according to superficial, deep, nerve supply and blood supply. When it came to the muscles, I would list every origin and insertion and action on a sheet with a check list. Before I began dissection, I would visualize them on a skeleton and visualize the actions. I learned the nerve and blood supply at this point too. For example, let’s say that I was looking at the muscles of the back. My first task was to organize them into extrinsic back muscles (associated with the movement of limbs) and intrinsic back muscles (associated with movement of the spine). I would then organize them into superficial and deep layers.

My coverage of the anatomy of the back would have started with organizing the anatomy into surface anatomy (my fiance was a willing model for this stuff), bony anatomy (learning all of the vertebral bones), spinal cord anatomy and then the back muscles. Associated with all of these lectures were embryology lectures on development of the muscles, bones and nerves. But back to the my organization scheme. The embryology lectures took place before dissection so that we had that background before moving into the lab.

Let’s say that today’s lecture included the muscles of the back. I would have my Netter plates (with annotations) and my key words from the objectives in my folder for that lecture (the material that I had prepared the evening before). I would listen to the lecture taking notes as I needed them and adding notes to my plates or on paper. We would then head off to the lab where I would look at the skeleton and trace out every origin (medial attachement) and insertion (lateral attachement) for each of the back muscles. Lets look at the Latissimus dorsi for a specific example. The medial attachement is the spinous processes of the six most inferior thoracic vertebrae and the lumbar vertebrae, inferiorly: the iliac crest and the thoracolumbar fascia and the inferior 3 to 4 ribs. This muscle inserts on the floor of the intertubercular groove of the humerus. By locating the origins and insertions of a muscle, I would be able to picture the action of that muscle as it contracts. In the case of the latissimus dorsi, I knew for sure that this muscle was not an intrinsic back muscle but functioned primarily on the humerus (an arm bone).

I would also learn the blood and nerve supply as I studied the skeleton. The nerve supply is the Thoracodorsal nerve which can be found heading through the axilla and to this muscle. One of my instructors like to say that the extrinsic back muscles “crawled out onto the back and took their blood and nerve supply with them”. This statement easily explains why the thoracodorsal artery is a distal branch of the axillary artery and that I could trace the small branches on the anterior surface of the latissimus dorsi muscle back to the distal part of the axillary artery which is a continuation of the subclavian artery. The nerve system is the same as the thoracodorsal nerve is a branch off the posterior cord of the bracheal plexus which travels to the LD muscle that is located on the posterior, inferior portion of the superfical back. In short, by organizing the material before heading into the dissection lab, I knew where to look for nerves and vessels; the actions of the muscle and bony landmarks all at the same time.

My GA class also required that we study radiographs, CTs and MRIs in addition to our dissection. I studied the available materials along with my dissections. When I came to the dissection lab, I had a checklist of all of the materials that I wanted to review and master. I can tell you that I was in the dissection lab at least 10 hours per week outside of the dissection lab times. On the weekends, I would review the week’s materials which usually took three or so hours. This study was done with my study group. I also looked at every cadaver in the lab weekly in addition to my own. We kept a running list of excellent dissections (more likely to be tested) at different tanks. We always asked permission before entering another group”s tank.

Another thing my study group did was ask one of the instructors (usually the course director) to spend 30 minutes quizzing us a week before the lab practical. He was totally willing to work with a five-student group. We asked him to be picky and brutal. Usually these sessions made us go back and work a bit more on our identification of structures. Our instructor was very good about telling us how to identify structures on a lab practical. He always liked to show us great landmarks.

The most important aspect of GA study (any course study) in medical school, is not to get behind. If you miss something (illness) you need to go immediately to where the class in and catch up on the weekend. Some students get behind and attempt to catch up and never get there. Again, catch up on weekends (they don’t lecture on Saturdays and Sundays). Also, don’t underestimate how much your classmates can be great resources for you. I never found a classmate who wasn’t willing to review structures with me in the lab. The biggest gunner gets an extra boost by helping classmates who are struggling. Everytime I reviewed something, I learned it that much better.

Some caveats: You cannot organize the material for your classmates. Each person has to find their own system and each person has to learn the material for themselves. Working with a study group helps to reinforce the material but each person is responsible for their own learning. Don’t even try to work with a group until you have done a thorough mastery of the material for yourself. If you are isolated, you lose out on the great reinforcement so don’t isolate yourself. If you have a family and other outside obligations, schedule some study group time even if it is minimal. Medicine is not a solo activity and you will have to rely on your colleagues when you are in practice. Medical school is good practice for learning to work as a group.

Well, the above is the essence of my system for GA and embrylogy. I can tell you that I spent plenty of time in the Gross lab and working on GA. It was interesting and it helped me appreciate my classmates even more. We all worked together and we all learned together. GA is not a course that you can sit down, memorize and master in a vacuum. You need feedback and your instructors/classmates are great resources. While there is much to learn and master, it’s not all rote memorization. My classmates that were great rote memorizers did fine on the tests but crashed on USMLE Step I in most cases. The understanders and intergrator (like me) did equally well on the exams and on USMLE Step I. It takes both.

I would also say that GA is not a course to be feared but a course to be mastered. A full 75% of my class failed the first GA lecture exam but only about 2 people failed the course itself. In most schools, you are not penalized for getting off to a slow start as long as you figure out what you need to do to get your information mastered. For me, GA was daily study, preparation and mastery. I also forged a great relationship with the GA instruction staff (I was the class rep for this course) so that we all could do our best. The instructors were not there to “fail” us but to help us master this neat course. In the end, it worked out fine.

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5 August, 2007 - Posted by | academics, Gross anatomy, medical school coursework

16 Comments »

  1. This Mastering GA post was really good. I am a first year medical student and having a horrid time on GA practicals, averaging about 70% on all 4 that I have taken. I’m pretty consistent – like 68-72-69-69 – but consistently bad or failing (<70%). I've tried to adapt and change my study habits to perform better. I have changed study group and also texts. I've expanded from Moore and Daley's to Rohen's Atlas to using either Thieme or Netter and also careful not to "overresource" myself. We do our labs in 4 hour blocks that are essentially student led. I've tried to use my lab time efficiently in our group of 6 (there are 32 groups of 6, each with own cadaver) to learn from my group and others. Any suggestions….please let me know. Just like you said, my written grades are good but GA studying and testing is another kind of skill, and one that I still need to practice and improve on. Thank you.

    Comment by James | 1 April, 2014 | Reply

    • To James:
      See if you can get one of your instructors to “cold-quiz” you on the spot. If you are not performing well on those spot quizzes, then ask for assistance in helping you to master the material. Don’t wait for another test but let one of your instructors put you on the spot on a regular basis until you are getting what you need. Being able to identify structures from their 3-D surroundings takes practice and organization.

      Comment by drnjbmd | 1 April, 2014 | Reply

  2. Hi! I was wondering how to ace gross anatomy and not just pass. So far, I’ve achieved approximately 68% in my first flag race and 65% in my 2nd flag race and wondering what I can do to get past the 80% mark for my final flagrace in 3 weeks’ time. Thanks! 🙂

    Comment by Jenny | 8 October, 2013 | Reply

    • To Jenny,
      In any class, one has to master the concepts thoroughly as opposed to looking for a certain grade “ace” or not. If you go for thorough mastery with preparation before lecture/lab, the grades will take care of themselves. Look at the methods that I used to prepare for class and to prepare for exams.

      Comment by drnjbmd | 8 October, 2013 | Reply

  3. wow, this was timely…… I was totally lost in my GA class. Its taken me weeks to really understand wat goes on in this class. I believe its not too late….. Imma catch up with the rest. Thanks

    Comment by Felisters | 14 March, 2010 | Reply

  4. Thanks, i really enjoyed reading the material. it is so helpful and precise.

    Comment by Benjamin Kondom | 24 February, 2010 | Reply

  5. Thanks. This was so helpful!!!

    Comment by mel | 5 July, 2009 | Reply

  6. you have an interesting to keep yourself up to ensure you learned everything about medicine.i read the whole blog and like it.I am a 3rd year medical student and honestly,i only start to love medicine while i start my clinical years eventhough quite sulky at first due to major posting that i have to endure(obs & gynae,medicine,public health and now,surgery.Maybe i was too lazy to relate everything during my pre-clinical years and always want to enjoy life(hang out,i means)after struggle hard for admittance to medical school.Anyway,i learn a bit there and here from your blog and want to start to study in a way that i could understand the patient and disease itself better.Maybe it will take me more time than the rest of us as i must read my pre-clinical also….Anyhow,nice to read about your chapter of life as medical students.have a nice day….

    Comment by logan | 10 January, 2009 | Reply

  7. OK, that makes a lot of sense. 😀 Thanks again!

    Comment by Alyssa | 8 December, 2008 | Reply

  8. I’m so glad that I’ve discovered this blog! Your posts are intelligent and insightful, and make me even more excited to start medical school. You have mentioned a few times that you have a study group. I was wondering how you chose the members of your study group. How did you guys get together? How did you know that they would be as dilligent as you or that they used the same study techniques?
    Thanks again for the wonderful posts!

    Comment by Alyssa | 7 December, 2008 | Reply

    • To Alyssa,
      My tank group was an automatic study group to begin with. After a couple of weeks, some of us that found ourselves together in the lab just met a bit more formally. We usually moved about alternating in an empty classroom, to one person’s house etc. Most study groups grow, shrink and change around. They happen pretty naturally as folks get about the business of study. Many people never study in a group if that works for them. You will find that you just kind of go with the flow and things happen. It ‘s not too complicated.
      Drnjbmd

      Comment by drnjbmd | 7 December, 2008 | Reply

  9. thanx..was feelin so scared..ya article surly gonna help me….. 🙂

    Comment by Sara Khan | 7 September, 2008 | Reply

  10. I have a GA exam on Tuesday over the head/neck – whew! I am really having difficulty managing it all. Rather than memorize, do you have any “compartment” type study advice? While I want to master it all, it’s just not going to happen.

    Comment by dailymeds | 4 July, 2008 | Reply

  11. Wow. This is great. I’m just about to start medical school and cannot thank you enough for sharing your experiences and offering such wonderful study skills. GA is something that I am worried about but I have no doubt that I will do well. Thanks again

    Comment by DocI | 25 June, 2008 | Reply

  12. I wish i saw this when i was in GA, would have helped a lot. but alas, even though i worked so hard i’ll be remediating anatomy this summer.. tear 😦
    these tips will come in handy. your blog is great.

    Comment by init2stay | 22 May, 2008 | Reply

  13. Your writing always encourages me. You portray yourself as articulate and knowledgable, and I truly enjoy that. Remain blessed.

    Comment by The Comeback Kid | 18 September, 2007 | Reply


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