Tips for studying anatomy

I often get asked if I have any tips on how to study anatomy, so I thought a post would be the right place to express my views on this. I need to emphasise that these are my opinions and I’m not an expert on education. There are lots of books on this subject, but I’m guessing you have more time to read a blog post than an entire book. With that said, I enjoy studying and teaching anatomy and have developed my own strategies based on the following principles:

  • Develop an overview of the region being studied
  • Embryology
  • Add knowledge in layers
  • Consider the functional significance
  • Learn about the clinical correlations

Before I expand on the above points, it is an undeniable fact that you will inevitably have to learn a large number of facts. We all learn in different ways, some students find drawing diagrams helpful, mnemonic devices, mind maps, models, play dough, and some prefer making their own notes or flashcards. Most of us use multiple methods, but the key is to understand the underlying concepts (basic overview, relevant embryology, and functional significance) first then learn the facts, then revisit and review the facts as often as possible.

Now I know many students appear to have an allergy to books, but you cannot solely rely on Google and Wikipedia. Sites like Teach me anatomy are great for an overview or as a refresher, but I wouldn’t recommend making it your only source for learning anatomy. You need to buy or find an online version of a core text that either the university recommends or you like. At UOB, Gray’s Anatomy For Students is one of the recommended books; for all of the criticisms levelled at it, I have to say it does have an excellent concepts section at the beginning of each regional anatomy chapter. Another source of anatomy content online, are YouTube videos; the issue of factual reliability can be somewhat variable, especially when video content is not peer-reviewed. Personally, I have come across a lot of errors in videos and would always recommend using your textbook to review material learned online. Two online video resources I would endorse though, are Acland’s Video Atlas and Dr Najeeb’s Lectures.

So remember my first point? You need to develop an overview of the area, so let’s take the head and neck section. The head & neck is a complex set of interconnected regions which are densely packed with structures. Having an appreciation of the different areas in the head and neck and how they relate to each other provides a framework for how structures pass from one area to another and how disease in one area affects adjacent regions. So as an example look at Figure 1, you can appreciate how the oral, nasal, maxillary sinuses, orbits and anterior cranial fossa are related. So it becomes clear to see that an infection in the oral cavity could spread through the erosion of adjacent tissues and spread into the maxillary sinus and then threaten the eye in the orbit. One can also appreciate how a basal skull fracture affecting the anterior cranial fossa (part of the floor of the cranial cavity) could communicate with the nasal cavity and cause a leakage of cerebrospinal fluid- giving rise to rhinorrhoea. Having a conceptual overview of each region builds the foundation for the details. So don’t just flick through the conceptual framework pages, read them and digest them, try and see how areas relate to one another.

Head and neck compartments

Figure 1 Adapted from Gray’s Anatomy For Students

Let’s talk embryology, seriously I can hear the sighs. Back in my student days embryology was taught as a separate discipline, that really didn’t help, however, at UOB there usually is an embryology worksheet each time you cover a particular region. This is important because if you have an overview of how the area develops, you will have insight into not only how congenital abnormalities develop but also appreciate normal anatomical peculiarities. So for example, have you ever wondered why the right recurrent laryngeal nerve stops in the neck, but the left travels down into the thorax before looping back up? Well if you read about the development of the aortic arches (yes plural, it’s not a typo) – that mystery will be solved! Why does the hearts postganglionic sympathetic supply arise from the neck and not the thorax? Many unusual anatomical features can be explained by understanding their embryological basis.

My third point was about building in layers, so once you have a conceptual framework of the head and neck spaces, structures and their relationships, add a layer. In this case, this often starts with the osteology and then goes on to the fascial compartments. Next, you may choose to study the arteries, veins and then the lymph nodes & channels. It is important to remember when adding each layer, again start with the basic overview. Let’s take the arteries, there is no point learning all 15 branches of the maxillary artery until you first understand how blood is supplied to the head and neck, then the extracranial and intracranial regions. The point being, build up each region gradually. As you learn each layer appreciate the relationships between each, especially concerning vessels and nerves and how they pass through and around bone and muscle. Don’t forget surface anatomy, this gives you x-ray vision, allowing you as clinicians to appreciate presenting symptoms and signs as well as helping with therapeutic interventions.

What does functional significance mean? Well, consider that we are subject to the moulding forces of evolution. As opposed to being perfectly designed, we are a product of mutations which gave us a selective advantage and allowed us to reproduce and pass on those beneficial mutations. Now except for vestigial organs (which used to have functional significance), most things in anatomy have actual functional importance. This means that the form of the organ has some relation to its function or vice versa. Compare the shoulder and hip girdles, both allow attachment of our limbs, but the shoulder girdles are not attached posteriorly, thus allowing each shoulder to move independently, allowing us to maximise movement of our arms and hands, permitting us to explore and interact with the world around us. The pelvic girdle, on the other hand is fixed anteriorly and posteriorly, sacrificing mobility for stability (compared with the shoulder girdle), hence the sacroiliac joints allow transmission of weight between the torso and the legs.

Learning the names of muscles and their attachments can be somewhat tedious, but it’s far easier and enlightening to consider their functional anatomy. An important concept to understand is that origins and insertions can be reversed, depending on which side of the muscle has been fixed. For example, when you are standing, and the trunk is stabilised, iliopsoas flexes your hip, however when your supine and your legs are fixed by your hip extensors, iliopsoas helps flex your trunk, allowing you to sit up. Another useful concept is that whenever a muscle crosses a joint, it will act on that joint. You can use that to understand the actions of any muscles. For example, quadriceps has two actions, the three vasti muscles are knee extensors, while rectus femoris extends the knee but also flexes the hip (because it crosses both hip and knee joints).

Last but not least don’t forget to consider clinical correlations, after all, your training to become clinicians, not anatomists. Learning why the anatomy is clinically relevant will help you become a better diagnostician, but also make it more interesting to learn. It’s far easier to remember things when they have relevance to us. Let’s take the thorax, I often ask students when discussing the relationships of the heart what is behind the left atrium? If I told you the oblique sinus and the oesophagus, you might remember it. However, if I explained that due to the proximity of the oesophagus and left atrium this provides a better way of obtaining clearer images of the heart (using transoesophageal echocardiography), in particular, the left atrium, septum, thoracic aorta and the heart valves, then the anatomical knowledge becomes clinically relevant. Understanding the proximity between the left atrium and oesophagus means you also appreciate that disease in one of the structures may affect the other, such as severe left atrial enlargement causing compression of the oesophagus and the patient presenting with dysphagia. Linking anatomy to its clinical relevance should help you remember your anatomy and hopefully make you better clinicians.

Regarding specific resources for learning clinical anatomy, most core books have small sections in each chapter, for more comprehensive resources consider looking at Clinical Anatomy By Regions by Dr Richard Snell or Clinical Anatomy by Prof Harold Ellis. For online resources check out Lachman’s clinical studies in anatomy.

I hope you’ve found this post insightful and please make sure you revisit your anatomy, not just before exams, but throughout your professional career, as with many things revisiting topics often yields greater insights.

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