Anatomical fugitive sheets revived: medical history as a stimulant for active learning and reflection

Goran Štrkalj and William Hunt
Macquarie University, Sydney, Australia (Summer 2017)

 

Figure 1. An anatomical fugitive sheet created by Jacob Frohlich in 1544 (Image source: Wellcome Library, London, CC BY 4.0).

Anatomy has traditionally been one of the foundation disciplines within the medical curricula.1 At the same time, it has been one of the most challenging subjects, both intellectually and emotionally. It also has a complex and controversial history burdened with occasional cultural and ethical transgression, particularly in the way human bodies were obtained for dissection and treated in laboratories. Anatomy educators have therefore faced various challenges, particularly in the last few decades, and have responded with many new teaching methods and resources. Importantly, a great effort has been made to install humanistic values into anatomy teaching. Humanities play a key role in this strategy as history, ethics, arts and, literature are increasingly used in anatomy education. This approach is seen as a new culture2 or a new paradigm3 and the transformed discipline itself as “new anatomy”.4,5

Following this approach, a novel educational activity titled the Anatomical Fugitive Sheets has been developed and implemented at Macquarie University in Sydney. The activity  encourages  active learning and reflection through the reference to the history of anatomy. It is implemented in the Introduction to Anatomy module, which presents basic concepts in gross anatomy, histology, and embryology. This prerequisite module provides grounding for other, more in-depth anatomy modules. A large number of students have enrolled (over 600 in 2016), mainly from medical and science disciplines, but also from social sciences, law, and humanities.

Figure 2. A screenshot from one of videos,
showing selected skeletal muscles.

The task for students is to create modern renditions of anatomy fugitive sheets. Fugitive sheets (also known as broadsheets and broadsides) were early educational resources for anatomy teaching, first used in the early sixteenth century.6 The annotated illustrations, usually contained a male and female figure and focused on a particular organ or body system (Figure 1). Medieval anatomy textbooks usually contained no illustrations. If illustrations were present, they were ornamental and highly schematic. At the beginning of the Renaissance period, capitalizing on the development of the printing press, fugitive sheets – the first form of modern anatomical illustration – emerged and immediately became a great success. They were made mainly for medical students but were also in demand from the general public interested in anatomy. Fugitive sheets differed in the quality of illustration and the accompanying texts. With time, more elaborate versions of fugitive sheets, coloured and with layered paper flaps showing different planes of the body, started to appear. Very few of these historical fugitive sheets have been preserved to the present day as they were usually single sheets of paper (easily lost or destroyed) that were heavily utilized for teaching purposes.

After receiving a brief introduction, students are instructed to carry out further research into the history of anatomy and produce a modern version of a fugitive sheet. They are asked to use modern technology to create an educational tool that might be of use to them and their fellow students in learning anatomy. Students have responded to this task with projects in a variety of formats. Relatively few students elect to create a traditional paper based project. A large majority of submissions are presented in an electronic format, using mainly Microsoft PowerPoint and Prezi. Technically, the most exciting projects are animations, most often in the form of stop-motion video (Figure 2).

Figure 3. A screenshot from one of the videos, showing the historical reference to Vesalius.

Some projects are presented as narratives that reference pop culture themes, arts, and a dose of local humour. In one superbly completed animated production (executed through the PowToon Platform), the main character is a young girl who had her heart “taken away” temporarily. The heart is enlarged and its structures and functions are explained to the viewers. Projects like this make the educational content more palatable and easier to understand.

Some projects have a strong emphasis on the artistic value of the presentation, using superbly crafted images and techniques in electronic formats. Some arts students informally communicated to their anatomy teachers that the project provided them with an opportunity to capitalize on strengths such as artistic ability, which are otherwise rarely recognized in science.

Historical references are often made, sometimes as short introductory notes about fugitive sheets, or in a more comprehensive manner (Figure 3). One ambitious project presented modern anatomical illustrations in parallel with those made by Leonardo da Vinci, one of the pioneers of modern anatomy and anatomical illustration.7 These illustrations are accompanied by comments on anatomy in Leonardo’s time and in the present day.

The Anatomical Fugitive Sheets project enables students to approach learning anatomy in a different, creative way. Good knowledge, reflection, and deep learning are essential in preparing this kind of educational resource in anatomy. This reflection includes contemplation on broader issues relating to anatomy and medicine, such as the ways in which human tissues have been obtained for education and been presented to learners. Modern anatomy education is offering more than knowledge about structures of the human body; it is a medium for the development of a wide range of skills and capabilities including professionalism and ethics.8 Connections with history and visual arts, such as those established and explored in the Fugitive Sheets Project, could play an important role in this.9,10,11

The humanities and social sciences will undoubtedly remain a significant contributor to the development and evolution of anatomy and medical education.

 

References

  1. Persaud TVN, Loukas M, Tubbs RS. 2014. A History of Human Anatomy. 2nd ed. Springfield: Charles C Thomas.
  2. Dyer GSM, Thorndike MEL. Quidne mortui vivos docent? The evolving purpose of human dissection in medical education. 2000. Acad Med, 75:969–979.
  3. Talarico EF. 2013. Change in paradigm: giving back identity to donors in the anatomy laboratory. Clini Anat, 26:161–172.
  4. Reidenberg JS, Laitman JT. 2002. The new face of gross anatomy. Anat Rec, 269:81–88.
  5. Štrkalj G. 2014. The emergence of humanistic anatomy. Med Teach, 36:912-913.
  6. Carlino A. 1999. Paper Bodies:A Catalogue of Anatomical Fugitive Sheets, 1538-1687. London: Wellcome Institute for the History of Medicine.
  7. Clayton M, Philo R. 2012. Leonardo Da Vinci, Anatomist. London: Royal Collection Publications.
  8. Chan LK, Pawlina (Eds.) 2015. Teaching Anatomy: A Practical Guide. New York: Springer
  9. Allen R. 2015. Art practice and bringing emotions to life in the anatomy lab: The story of an artist in residence. In: McLean CL (Ed.) Creative Arts in Humane Medicine. Edmonton: Bruch Education, p. 82-97.
  10. Dosani F, Neuberger L. 2016. Anatomy and humanity: Examining the effects of a short documentary film and first anatomy laboratory experience on medical students. Anat Sci Educ, 9:28-39.
  11. Štrkalj G. 2016. Humanistic Anatomy: A New Program for an Old Discipline. New York: Nova Science Publishers.

 


 

GORAN ŠTRKALJ, PhD, is an Associate Professor at Macquarie University in Sydney, Australia, where he teaches human anatomy to health professions and science students.

 

WILLIAM HUNT, BSc, is a postgraduate student in physiotherapy and tutor in anatomy at Macquarie University in Sydney, Australia.

 

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