ATLAS-plus: Multimedia Instruction in Embryology,Gross Anatomy, and Histology

CM Chapman; JG Miller, MILS; LC Bush, MFA; JA Bruenger, MA;WJ Wysor; ET Meininger; FM Wolf, PhD

Learning Resource Centerand

TV Fischer, PhD; AR Beaudoin, PhD; WE Burkel, PhD;DK MacCallum, PhD; DL Fisher, PhD; BM Carlson, MD, PhD;

Department of Anatomy and Cell Biology,

University of Michigan Medical School3960 Taubman Medical Library

1 135 East Catherine StreetAnn Arbor, MI 48109-0726

Abstract: ATLAS-plus [Advanced ToolsforLearningAna-tomical Structure] isa multimediaprogram usedto assist inthe teaching of anatomy at the University of MichiganMedicalSchooL ATLAS-pluscontainsthreecourses: His-tology, Embryology, and Gross Anatomy. In addition tothe three courses, a glossary containing terrmsfrom the threecourses is available. All three courses and the glossary areaccessibleintheATLAS-plusenvironment. TheATLAS-plusenvironmentprovidesaconsistent set oftoolsandoptions sothat the user can navigate easily and intelligently in andbetween the various coursesandmodules in theATLAS-plusworld. The program is a collaboration between anatomyand cell biologyfaculty, medical students, graphic artists,systems analysts, and instructional designers.

STRUCTURE AND FLEXIBILITY

ATLAS-plus is a software program that integrates text,images, andanimations todynamically teachbasic conceptsand principles of several anatomy disciplines. A "modifiedhypermedia approach" has been used in designing the pro-gram. [1] When development firstbegan in 1989 twobroadcategories of computer assisted instruction were found:page turners and Hypercard-like stacks with many optionsand little structure. The page tumers are good for insuringthatastudent sees all ofthe importantmaterial inalesson butthey are very linear and rigid, making it difficult for thestudent to review or create a custom lesson path. Con-versely, the newly evolving hypercard stacks and similarmediums provide the user with greater flexibility; howeverit is easy for the user to get lost in the program, making itdifficult for the student to use hypermedia effectively as alearning tool. In short, what might be a great tool for the

expert who already knows the territory of the subject matteris not as useful for the studentwhoneeds the tool to help himor her learn specific topics.

As a result, the ATLAS-plus team at the University ofMichigan developed design techniques that provide bothstructure and flexibility. Structure is important so thatstudents have a suggested path through the material, andexpectations and learning objectives are clear. As well, it isimportant to provide both physical and contextual orienta-tion. Yet, for the advanced or adventurous user, the flexibil-ity of a true hypermedia environment is provided. Usingpull down menus, hot buttons, and other navigational fea-tures, users can easilyjump to a glossary or any of the threecoursesorcourse submodules. Images can be looked atwithdescriptions, without descriptions, or compared to eachother.

COURSE CONTENT

ATLAS-plus is a dynamic program: new and better designtechniques areconstantlybeing developedandimplemented,course material is being added and revised, and use in thecurriculum is being rethought as course directors change,others hear of the program, and as the Medical Schoolrevises itscurriculum. Overall, thosewhohaveusedATLAS-plus have responded favorably. It has gone from being anunrequired resource available as a stand-alone programavailable on 6 machines, to being required for some topics,available over a network in a new computer lab with 22workstations dedicated primarily to delivery of ATLAS-plus. As much as ATLAS-plus has evolved, the foundationof the project remains the three basic science courses:Histology, Gross Anatomy, and Embryology.

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ATLAS-plus sprang from a software project designed as aresource toremediate students whowerehaving difficulty inHistology. Students werereferred tocomputerizedmatialsbefore spending significant time with faculty. After com-pleting theprogram the studentwouldbe able tomake betteruseofthe instructor's time. Theoriginalprogramwas simplyanother tool at the student's disposal which would teach thestudent basics, freeing up instructor time for specifics.

From this initial success, plans were made to develop acomprehensive setofmodules to teach Histology, Embryol-ogy, and Gross Anatomy. The ideabehind the constructionof these modules was to create a program that would intro-duce students to material and provide them another learningtool that they could use with lab, lecture, and text. ATLAS-plus was never designed to be the sole resource studentswould use to learn the subject material. A Gross Anatomycomponent is not intended to replace an actual dissectionlaboratory session.

Histology

The ATLAS-plus courseware for Histology can be thoughtofhaving two major types of instruction: Laboratory Intro-ductions (or "Lab Intros") and Tutorials. In theory, thereshould be a corresponding Tutorial for each Lab Intro. Todate, more Lab Intros have been developed than tutorials;Lab Intros are easier to create. Figure 1 lists currentlyavailableLab Intros and Tutorials available in the HistologyCourse of ATLAS-plus.

only, ofmw -e up Do four scaled images ata time (Figure 3).

Students are instructed to use the corresponding ATLAS-plus Laboratory Intoduction before attending laboratory

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Figure 2. Textrimage pair from a Lab Intro.

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Figure 1. Histology Course Laboratory Introductions.Titles with an * contain both a tutorial and a lab intro.

Lab Intros correspond to traditional topics that introducetissue and organ structure. Each topic in the ATLAS-plusHistology program corresponds to scheduled lectures andlaboratory sessions. TheLab Intros use atwo screen design.The left screen contains a description ofthe image displayedon the right screen (Figure 2). Students can go thrugh eachLab Intro sequentially or they can use a directory to ran-domly jump to text/image combinations, look at images

Figure 3. Compare mode. Top screen is the directory. Bottomscreen holds the images.

sessions. Representative images which are clearly describedand labeled can be seen by all students. These Lab Introsprovide each student with a solid orientation to the materialthat is covered in the laboratory with a microscope andmicroscope slides. In contrast to ATLAS-plus images,microscope slides do not have labels and often have struc-tures that are difficult or impossible to identify. Addition-ally, special "demonstrations" are included in theLab Introswhichallow theentire class access to goodexamples ofcellsor products using special stains or immunohistochemistry.Using theLab Intros properly, the studentsarebetterequipped

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to make constructive use of their laboratory and theirinstructor's time. Lab Intros are also available for reviewbefore examinations.

Histology Tutorials differ from Lab Intros in that the Tuto-rials go into more depth than Lab Intros. Lab Intros empha-size the identification andnaming of structures, while Tuto-rials focus on process and concepts. For example, the LabIntro on bone teaches one to identify different areas in thedeveloping bone, while the Tutorial teaches how bonegrows. When using a tutorial, students can refer to theaccompanying Lab Intro, or any other course module inATLAS-plus.

The original course design was to have one tutorial for eachlaboratory introduction. But, as shown in Figure 1, Labora-tory Introductions far outnumber tutorials. This is becauseithas proven farmore difficult tocreateaTutorial than aLabIntroduction. We have found that the overall design for aLab Intro stays the same foreach module: thenumberoftext/image pairs may change foragiven areabut the navigationalstructure carries over from module to module. Once theimages have been digitized and labeled, and text has beencreated, putting them into a lesson is straightforward. Tuto-rials, on the other hand, tend to take more time. We havefound that module design does not necessarily transferfromtopic to topic: eachmodule must be thoughtout and instruc-tional strategies may differ depending upon the topic beingdiscussed. In addition, Tutorials often make use of illustra-tions and animations thatrequire the collaboration among anartist, content expert and designer. Generaly, hand drawnilustrations andanimations takemuchmore time toproducethan digitizing and labeling images. Tutorials therefore takemuch more time to create than Lab Intros because of thecomplexity ofdesign andaccompanying illustrative materi-als. Current development efforts are focussing on revising

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andrewriting currentLab Introductions (reshooting images,rewriting text, adding special "demonstrations", and creat-ing montages), as well as filling out the course with severaladditional areas.

Gross Anatomy

The Gross Anatomy course consists of four main areas:Overview ofAnatomy, Introduction to Anatomy, SystemicAnatomy, and Regional Anatomy. The sections progressfrom elementary to advanced, finishing with RegionalAnatomy in which images and descriptions of dissectedcadavers are presented to the student.

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ANATOMY OF SYSTEMS

Figure 5. Menu of Instructional Modules for SystemicAnatomy. Modules with a graphic identifier have beencompleted.

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Figure 4. Representative screen from "Intouction toAniatomy" section of Gross Anatomy lesson,

Figure 6. Example screen from the Muscle Lesson.

Overview of Anatomy and Introduction to Anatomy.These two sections provide an overview and introduction toGross Anatomy as it is taught at the University ofMichiganMedical School. The basic terminology necessary to teach-ing anatomy is discussed and defined. Figure 4 shows arepresentative screen from the "Introduction to Anatomy"section of the Gross Anatomy course.

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Systemic Anatomy. In this section, the basicbody systemsare discussed. Figure 5 shows the Systemic Anatomymenu.The level of detail in these units is basic. They can be usedas a review by those students already having a basic sciencebackgroundor as aprimer for those studentsnew to this area.Simple illustrations and text are used. This material is basicenough for students in high school and undergraduate col-lege courses. The modules in this lesson make use of anumber of illustrations and animations, and Quick Timemovies are in the process ofbeing incorporated into lessons.Figure 6 is a screen from the Muscle Lesson; it is represen-tative of screens in other system modules.

The Overview, Introduction, and Systemic lessons are de-signed to be used early in the study of gross anatomy,preparing thestudentfor thedissections inRegional Anatomy.

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Regional Anatomy. This section contains the main mate-rial of the Gross Anatomy course. The body is divided intoregions, each presented with a series of digitized, labeledimages ofactualdissections, andaccompanied with atextualdescription. Like the design in the Histology/lab introduc-tion sections, a two screen system is used. The left screencontains a description and orientation illustration of thedissection image on the right (figure 7). A directory can beused to select text/image screens at random or simply tobrowse images.

These modules are designed to prepare the student for theirlaboratory assignments, in the same fashion as the Histol-ogy/Lab Introductions. Each module corresponds to aspecific set ofdissections foragiven laboratory assignment.Students prepare for the dissections by using the computer-

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Brachial Plexus

As you study these photographs of the brachial plexus, please refer tothe diagrams in either Woodburne & Burkel (P. 1 2) or Netter (Plaw405).

The brochial plexuis is formed by the venWrirsmfdfcervfinervesfivethrouh Wl/ andthefirs thoracc nerve Smalicontributions are sometimes made by the fourthcervical and second thoracic nerves. The ventralrami are considered the roots of the plexus andthey emerge between the anterior and middle 0scalone muscles. Five stages of brachial plexusformation are recognized.

Figure 7. Text/image pair from a represen-tative Regional Anatomy dissection lesson.The upper left screen appears on the leftmonitor and the lower right screen appearson the right monitor.

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Figure 8. Embryology Course Menu.

ized exercises. These modules may also be used later forreview. This is especially important in Gross Anatomybecause after a student dissects a region it is difficult, ifnotimpossible to review that material, since the tissue is de-stroyed. As is the case with most of the ATLAS-plusmodules, these materials are not intended to replace actualdissections, although they mightbe used in courses (nursingfor example) where students are taught gross anatomy butdo not do dissections.

EMBRYOLOGY

Embryology is different than Histology andGross Anatomy,in that it is presented as one large tutorial covering the entireEmbryology course taught at the University of MichiganMedical School. Originally it was conceived as a series ofmodules that were to be an adjunct to the lecture componentof the course. The modules have been expanded so that astudent can attend the lectures or do the computer-assistedinstruction and receive the same basic material. Studentscan use the computer modules to review lectures that theymissed or found difficult. Figure 8 shows the EmbryologyCourse menu.

Embryology usesmore animations and illustrations than theother two ATLAS-plus courses. The finishing touches arebeing puton thecoreEmbryologymaterial, whereupon thelessons will be enhanced with additional malformation im-ages. For future versions of the program, we are alsoexperimenting with such features as 3-Dimensional recon-structionsofthe developing embryo from serial histologicalsections (Figure 9).

CONCLUSION

ATLAS-plus is a software program that integrates text,images, andanimations todynamically teachbasic conceptsand principles of several anatomy disciplines. A combina-tion of instructional design that provides for structure andflexibility in a hypermedia environment, and carefully con-sidered contentemphasizing basics and advanced topics hasmade ATLAS-plus a program that can support a variety ofusers and uses. In addition, the solid foundation that theATLAS-plus program is builton will allow us to expand theprogram to incorporate advances in visualization and otherareasofcomputer andeducational technology without aban-doning the core program. Currently in use at the Universityof Michigan, portions of ATLAS-plus are being tested atMichigan State University and will soon be available toother individuals and institutions.

ACKNOWLEDGMENTS

The ATLAS-plus project has been supported in part bygenerous donations from Apple Computer, Inc. and SandozPharmaceuticals, Inc. Supportformedical studentcontribu-tions to ATLAS-plus has been provided by the Office oftheDean, University ofMichigan Medical School. Additionalproject support was provided by the Center for Research onLearning and Teaching (CRLT) at the University of Michi-gan.

References1. Love SJ, Chapman CM, Connelly TG, Ten Haken JD:Design techniques for ensuring structure and flexibility in ahypermediaenvironment Mtimed Review; 2(2): 34-43

Figure 9. Example of a three-dimensional reconstruction of a developing embryo from histological sections.

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