Course: Anatomy of the Abdomen and Pelvis
School/platform: Leiden University (Netherlands)/Coursera
You will explore the 3D anatomy of the organs from a basic level, providing thorough anatomical understanding, to its advanced application in surgical procedures. This course will challenge you to discover and help you to understand the anatomy of the abdomen and pelvis in all its aspects, ranging from its embryological underpinnings, via digital microscopy to gross topography and its clinical applications.
One of the particular benefits of MOOCs is the ability to take courses from universities all over the world. I’ve taken courses at two Netherlands universities now, and I have to say, Dutch professors are awesome. That, and my enthusiasm for the subject material, might’ve had something to do with how much I enjoyed this course. It wasn’t the slickest MOOC I’ve taken, in terms of production values, but I’ll trade slick for heart and content any time, and this was loaded with both. And with guts.
I was a little uncertain at first, since we started at the “first comes the esophagus then the stomach” level. I shouldn’t have worried. The material often was presented in what I’ve come to think of as a spiral manner: the first pass includes the most general information, then successive passes go into more and more detail, meaning repetition and connection that helps everything stick. So while the abdominal muscles were mentioned in the first week, it wasn’t until Week 5 that we really dove into the details of origin, insertion, and action. Every week mentioned aspects of embryological development, tissue histology, and clinical practice, so that by the final, I was able to distinguish between a stained slide of the duodenum vs ileum, determine which embryonic features turned into which adult structures and which just melted away with growth, and could consider the path of referred pain to various sites.
The course was set up in six weeks (there is a seventh week, but it’s only to include a final exam) and, because of the new structure of the Coursera platform (sigh), all the material is released at once. The only requirement to pass the course was to score at least 80% on each weekly unit exam, and on the final. But there was a lot more than that available.
The material for each weekly unit included numerous videos: some were lectures, some cadaver and live dissections (these came with trigger warnings for the squeamish, who probably aren’t going to be taking abdominal anatomy anyway), a few were animations, stained slide presentations, and laparoscopic videos. Readings were also featured, sometimes reiterating the lecture material, sometimes supplementing it. There were numerous ungraded practice quizzes as well as “e-tivity” (extra points for that term, though I can’t decide if I love it or hate it) posting prompts such as: Find a couple of sources with information about (the allantois/tubal pregnancy/aortic aneurysms) and write a paragraph or two addressing specific questions. Though these weren’t graded, looking for information through reputable sources (NIH, peer-reviewed publications) and just looking through the answers of other students was extremely helpful; we all seemed to focus on different aspects. Because so many students seemed more well-prepared than I, after a while I got intimidated and stopped submitting my clumsy answers, but the rest of the process was still quite valuable.
Some weeks used a subset the University’s CASK system (online Clinical Anatomical Skills). This included a lot of elements, some of which I found more helpful than others. I was completely unable to figure out the “view a cross-section of the body by any two planes” feature, similar to the Sylvius 4 system from Duke’s Neuroscience. I think more detailed instructions – perhaps a mini-tutorial – might have helped, but no one else complained, so I’ll take the hit for technical mediocrity and impatience. I also found the histology section to be confusing, but I wasn’t sure what I was looking for; again, a more structured approach might have been beneficial, though I might have just flubbed through that as well. I did find the Q-and-A for some sections, like embryology, to be extremely helpful, though inguinal anatomy remained a mystery to me until I found some videos on Youtube. Which, by the way, was encouraged all along; several collections were recommended. There’s a great deal of basic medical education on Youtube, and I mean the real thing, not somebody’s high school biology project.
One of the standout moments of the course came in Week 4. Let me tell you, peritoneal development is complicated business. From about 6 to 11 weeks, an embryo’s intestines are kicked out of the body because there just isn’t enough room, and they twist and rotate in an astonishing peritoneal ballet to fit back in and get everything in the right place, all the while other things are moving around. Every time I take one of these courses, I say again I can’t believe everything works, since it requires so many things to happen just so. But the thing here was the demonstration: a few years ago Dr. Gobée (one of many instructors involved in the course) constructed a giant working model of all this for his medical students, with the stomach and liver that rotate the way they do, and an aorta and vena cava and pancreas and, especially, intestines that extend and twist and retract the way they do, and everything with a plastic peritoneum draped over it, just so we could see exactly what happens and why the peritoneum ends up where it does. It was a great model, and highly instructive. Here we are with dozens of animations of gut rotation on Youtube, and sophisticated imaging technology via CASK, but this model drew more positive comments on the discussion forums than anything else in the course. If you build it, they will come – even if it isn’t the slickest technology.
My personal funny bone was tickled by the head on the anatomical diagram shown here. Most of these diagrams were headless, since we’re more interested in the muscles and organs than the face (or the unflayed exposed parts, which I’ve censored so this blog won’t get flagged for x-rated pictures; I have enough trouble with some of the passages I quote in my literary posts), but in this case it was kind of hilarious to have some Zoolander looking back, as if to say, “Well, whaddya think?” I still don’t know if that diagram was photoshopped or if some print material includes it. Some of the module titles also made me smile. “Knowing your peritoneal relationships” isn’t networking advice, and “The Gems of the Pelvis” turned out to be the female reproductive organs.
This was the first time I’d encountered the kind of pre-testing I’ve encountered in math classes: questions on material that hasn’t been taught yet. I’m still not sure if the motivation was to encourage us to find information on our own – construct our own learning, as the phrase goes in math ed – or to prime us so that when we encountered the material, it was something we’d already thought about, as was used to very good effect in a recent calculus course (which I still haven’t talked about, I’ll get there, I promise, I’m still recovering). I was caught off guard at first, but once I realized I could look things up, I started having a lot of fun. And constructing my own learning. See, it works. However, I do think the course relied a little too much on the “go out and find some material on this” approach.
The graded exams – one per week, plus the final – were challenging in that, unlike the practice exams where the incorrect questions were marked as wrong with perhaps a hint as to the error, no feedback at all was given, only a score. Unlimited attempts were permitted, but only after 30 minutes had elapsed since the last attempt. With no indication of which question I’d gotten wrong, I only had so much patience for fumbling around trying to find it after I hit the pass mark. I should say, however, that the questions were great: a few of them were straightforward information retrieval questions, but most of them required putting together multiple kinds of information, like knowing not only what nerve system runs close to the aorta, but what the effects of damage would be. Then there was the one that required knowing 1) how the stomach absorbs medications and into what vessel; 2) where that vessel goes, and 3) picking it out on a CT slice. I wish I knew if I’d answered that one correctly, because it was Gem of Put-it-all-together Questions.
Of course, you have to really want to know this stuff, either because you need to know it for future coursework or career, or because you just like medical stuff, which is my thing. And you have to be a little patient with a course that doesn’t fit into the cookie-cutter mold. But I’m happy to see oddball MOOCs, I’m thrilled to see teachers who put some thought into how to teach, and I greatly enjoyed this course.