A Brave New World: Reflections on the Challenges of Relational Anatomy as a Former Humanities Major

 Description: 

Early in the Relational Anatomy tutorials this semester, we were asked to explore the peritoneum and gastric system through CT scans in the e-Anatomy platform in all three planes. To prepare, I printed out textbook diagrams illustrating the primary imaging planes (axial/transverse, coronal/frontal, sagittal, oblique) along with the directional terminology and diagrams of various peritoneal structures and taped those to my wall. I took detailed notes during our introductory tutorial when our instructor 'scrolled' us through e-Anatomy, capturing tips like "remember left and right sides -> identify by surrounding anatomy," and "is this kidney left or right? identify by finding spleen or liver," and "always double check where the over and spleen are; aorta is on the left and IBC [sic] is on the right." 

However, being so new to anatomy, my notes made little sense to me; I did not know how to differentiate the liver from the spleen, nor which I would find on what side of the body, or that the term was actually IVC or what it stood for. When I opened e-Anatomy to complete the first tutorial worksheet, searching for spatial regions like the paracolic gutters, the hepatorenal recess and the falciform ligament, I used the search box to locate the labels for each of the structures/spaces and could not fathom how I would ever find these without labels.

Recognizing that I was lost, I joined my recently-formed study group of Cassie, Dana, and Crystal, and we continued on the worksheet together. We spent over an hour trying to orient ourselves in the axial plane. I understood the anatomical position where the patient's left is on the observer's right. However, applying that to the axial CT view, where the patient is supine with feet facing the observer, but the fact that we are scrolling superior to inferior disoriented me. We debated why the liver was on our left side. We knew the liver would be on the right side of the patient and therefore since we were seeing the lever on our side, the patient was in the anatomical position, and in the end, we needed to step back and accept that this is how CT axial scans work. 

We continued through the worksheet and found that the falciform ligament is in the anterior of the liver, that the paracolic gutters are lateral to the kidneys, and that the hepatorenal recess (Morrison's pouch) is slightly lateral and anterior to the right kidney and medial to the right lobe of the liver. 

Feelings: 

Coming into this imaging program as a mature student with an extensive background in the humanities meant not only changing gears, but also changing direction. Over 25 years, I have navigated complex professional environments and writing assignments, but entering the world of anatomy feels like being a foreigner in a new world. There is a new language, a new landscape, and none of my familiar landmarks are helpful for navigation. I am a perfectionist, and feeling lost and unsure of where I am or which direction I am heading in is an unfamiliar and deeply uncomfortable place for me to find myself. 

In the first weeks of the program, I realized that my previous life experience was not going to give me a leg up in Relational Anatomy, Pathology, or Anatomy and Physiology. I felt overwhelmed with the cognitive load and the weight of the expectations of the program. I often felt embarrassed in class when other students chimed in to offer their explanations using a language I had only just been introduced to but was as yet unable to use to form coherent sentences and explanations myself. 

After completing our 5th week of classes, I am beginning to build some confidence. I understand that learning relational anatomy is unlike anything I have ever learned before. While the expectations of this program still honestly feel unrealistic, I am learning to shift my definition of success. Instead of chasing a 90% at the cost of my sleep, health, and much-needed family time, I am learning to focus on both understanding the material and, as the first week in Anatomy and Physiology taught me, maintianing homeostasis. Achieving a solid 80% and keeping a connection to my husband and children is more sustainable long-term in this program. 

Evaluation: 

Through our tutorial quizzes, I have realized that I may not know all the structures in an area, but by being able to identify anchor structures on a scan I can use what I know to form an educated hypothesis. In other words, making a correct educated guess on in a quiz is more than luck; it's making use of all of the time I spent studying e-Anatomy and scrolling back and forth. 

As soon as I finish a quiz or test, I open e-Anatomy to find the images that I struggled with to see if A) I answered the questions correctly or B) how I could have come to the correct answer by looking at other structures. Through continuous reference to e-Anatomy, I no longer have to turn on the tags to name the main structures, and I am more familiar now with the 'practice' feature and turn off the labels so that I can practice identifying them as I scroll through the scans. 

I have been building a community of peers to not only study with but process the stress with a as well. I work regularly with Dana, Cassie, Crystal, and now JJ from NucMed, to help make sense of what is being asked, the best way to find the information, and how to make sense of what we see. I connect with Iulia from MRI every day for Relational Anatomy to go through Visible Body content together. I have formed relationships with second year students in order to help gain an understanding of the bigger picture of this program and what kind of study habits they have found the most useful over the past year.  

I have been learning the language of relational anatomy and, much more slowly, the anatomy itself. As such, the notes that I make for myself when going through the worksheets are now much more detailed. Below, you can see my notes from the first tutorial worksheet vs those of my notes from the most recent tutorial worksheet. 

Notes for first tutorial worksheet vs notes for 3rd tutorial worksheet

I have also now met with the instructor once 1:1, and once with my study group. In my previous life of perfectionism, I saw seeking clarification and extra instruction has been for those who are "less academic" and in need of remediation. Allowing myself to admit that I need the extra assistance has been difficult for my ego but has also been extremely beneficial. Our study group intends to continue requesting meetings with the instructor throughout the semester as we move into other regions of the body. 

Analysis: 

Reflecting on my journey with e-Anatomy makes it clear that understanding cross-sectional imaging requires far more than just memorizing terminology on a page. It demands a working knowledge of how various tissues, fluids, fats, and gasses show up on an image, alongside an intimate knowledge of anatomical neighbours and spatial relationships. It requires an understanding of where these structures should live in relation to each other and within their cavity. 

An example of this occurred on recent test question. In the slide below, I expected to see gas in the ascending colon, positioned slightly more lateral and anterior. However, looking at the image in e-Anatomy after the test, I know that the ascending colon is anterior to the right kidney and lateral to the duodenum. I could have and should have been able to infer that the answer was ascending colon based on those relational structures. Recognizing anatomical neighbours can help me name a structure when the structure does not appear where or how I expect it to look.

Slide 38/303, Abdominopelvic cavity - CT-Scan (Transverse), e-Anaotmy

In one of my earlier tests, I missed points because I could not identify the hepatic portal vein and the splenic vein pictured below. 

While I still have a hard time differentiating the structures in that light grey crescent shape, after spending much time learning the positioning of the abdominal aorta, the IVC, and the fact that the left renal vein comes off of the IVC anterior to the abdominal aorta and posterior to the SMA, I know that the hepatic portal vein, the SMV, and the splenic vein form that crescent around the SMA. I also know that the uncinate process of the pancreas curves around the SMV anteriorly, so in a slightly superior view, I would see the hepatic portal vein and the splenic vein on the lateral portions of that crescent.

Slide 82/1074, Abdomen - Pelvic - CT (Axial cross section), e-Anatomy

Ultimately, these experiences show that an individual CT scan slice does not exist in isolation.  I am slowly improving my understanding in that aspect; by scrolling superiorly and inferiorly, anteriorly and posteriorly, or medially and laterally, I can see the necessity of being able to predict where the structure should move as I scroll or what structure I will encounter before or after it. 

Conclusion: 

Taking the time to look back has shown me how far I have come in this course and the world of relational anatomy in only five weeks. As a mature student with limited science and no anatomy and physiology in my background, stepping into the complex world of imaging was daunting and overwhelming. 

This class required a shift in how I approached my studies - first in the shift from studying words to studying spatial structures and relationships, second from studying in isolation to studying in groups, third from thinking I should be able to understand the subject on my own to reaching out to the instructor to ask for guidance, and finally in the shift from expecting perfection from myself to giving myself the space and grace to explore and answer with the possibility of being wrong. 

While I have much to learn and more to master in e-Anatomy, I often find the navigation of the anatomical structures easier in e-Anatomy than in that of Visible Body. Being able to recognize the moment when the left renal vein crosses anterior to the abdominal aorta and the SMA immediately lets me know that I should be able to see the neck of the pancreas anterior of the vertebral column and the splenic vein and SMV directly posterior to the neck of the pancreas. I should be able to see the pylorus of the stomach, the midsection of the left kidney, and the superior pole of the right kidney. 

While I cannot yet say that I know the same for every level of the abdomen, I can clearly see the learning that I have done and the connections that I have made at that level. 

Action Plan: 

Moving forward into the rest of the term, I will continue to make use of the learning strategies that I have already put into place; I will continue to first work on tutorial sheets on my own before meeting with my study group and invite our instructor to join us when we are struggling with making relationships or identifying certain structures, I will continue to work on balancing my expectations of myself and celebrate the small wins that I experience. I will also remain open to changing my approach, as I have already changed my methods several times and I may encounter a way of studying that works even better. 

Understanding that sometimes I need to make educated guesses on tests is helpful, but I also need to remember to stop and ask myself what I know about the structures in the targeted area of the scan and what I can infer based on what I know to be true. 

I am investing the necessary time, effort, and reflection into this program. By continuing these habits, I will be well-equipped to handle the rest of the term.