Medical Teacher, Vol. 14, No. 4, 1992
375
SHORT COMMUNICATION
Med Teach Downloaded from informahealthcare.com by University of Sydney on 01/04/15 For personal use only.
Anatomy of the upper limb: a partnership in learning and assessment
BARBARA TYLDESLEY, Department of Occupational Therapy, Liverpool Institute of Higher Education, PO Box 6, Liverpool L16 9JD
SUMMARY Specific rehabilitation of the upper limb by the Occupational Therapist requires a sound working knowledge of the anatomy of the pectoral girdle, arm, forearm and hand. To aid the learning process the Liverpool occupational therapy students are given their assessment topics at the beginning of the course. They find a conducive partner with whom to work and practice, and together they prepare for the oral demonstration which forms the assessment test at the end of the second term. Each student completes a questionnaire at the end of the fourth term. This is designed to ascertain how confident the student felt, and how well they retain their anatomical theoty of the upper limb for clinical work.
Introduction Student occupational therapists learn anatomy in the first year of the Occupational Therapy course so that they appreciate the way the body is constructed and how one body segment behaves in respect to another. Anatomy is of paramount importance for the biomechanical approach to occupational therapy. “The biomechanical approach to treatment applies the mechanical principles of kinetics and kinematics to movement of the human body. . . and are appropriate for patients who have problems which directly affect their range of motion, strength, or endurance necessary to perform daily life tasks” (Trombiy, 1983). The mechanics of the joints and muscles of the body, together with the nervous control of these components enable us to move with power, speed and precision but, if these mechanics are disturbed by disease or injury, motor patterns may be altered, joints stiffen and muscles lose their full potential. The learning processes involved in the appreciation of specific anatomical terminology and factual information about the assembly, relationships, attachments of soft tissue includes listening, seeing, doing and experiencing. Elements of each of these
376
Barbara Tyldesley
aspects of learning are incorporated in the delivery and study of the anatomy of the upper limb, with the Oral Assessment test completing the sequence.
Med Teach Downloaded from informahealthcare.com by University of Sydney on 01/04/15 For personal use only.
Teaching, learning and assessment At the beginning of the anatomy course each student receives a ‘work pack‘ containing diagram outlines for use during the overview lectures when diagrams are labelled, extra structures added and relationships explained. Visits to the Department of Human Anatomy at the University allow the three dimensional layering of the soft tissue to be understood and recognized, making it easier for students to explore their own limbs and those of a chosen partner and to identify the palpable areas and the muscles performing specific movements. The work pack also contains functional anatomy exercises which are ‘peer mediated’, introducing the paired students to new learning strategies and encouraging them to discuss and analyse the workings of the upper limb. Peter Rosenbaum (1973) identifies that students working together foster an interactional intensity of learning which he considers engenders mutual cooperation and satisfaction.
The oral anatomy examination Ten topics covering the upper limb are listed for the examination and are given out at the beginning of the course. The aims for the anatomy section of the syllabus are “to encourage the students to handle and look at their own bodies and those of others to familiarise themselves with surface markings, recognition of movement and the relationship between the superficial and deeper structures” (BScOT Syllabus 1989). The examination is designed to test the accuracy of the student’s “demonstration of’ and “knowledge of” the area under discussion and their understanding of the role of the various components of the musculo-skeletal system in the movement patterns of everyday living. It is hoped that the material thus learned will become part of the working vocabulary of the student and the process of post-examination amnesia will be reduced. The students select their own partner and are encouraged to work together to learn, understand and demonstrate palpable structures. This peer teaching and participation satisfies the desire to help others as well as promoting an intrinsic feeling of satisfaction and self esteem. “The overriding consideration in any learning situation is to have a happy and secure emotional ‘climate’ created through satisfying, consistent, harmonious relationships and interesting and meaningful projects” (Davies, 1986). It must be pointed out that despite the comparatively sheltered and cooperative style of learning involved, the actual examination has its own stresses. Many people find that expressing themselves verbally in an examination situation is more difficult than the act of writing similar information. Concentration has to be sustained and the fear of forgetting is greater. In an oral examination the examiner must be constantly mindful of these stresses and assist candidates to perform to the best of their ability by responding in an encouraging way when the candidate is doing well, and by careful questions when certain facts have been omitted.
Presentation of the questionnaire Three cohorts of students have completed the questionnaire at the end of the fourth
Learning anatomy
377
term. It is presented without any forewarning, the contents and aims are explained and the anonymity of all participants emphasized. Most students have been rather taken aback by the prospect of filling it in but have been game to try, and despite the initial expressions of incredulity the results of the questionnaires have been encouraging.
Results
Med Teach Downloaded from informahealthcare.com by University of Sydney on 01/04/15 For personal use only.
Not all the students enjoy this style of learning but most seem to find it more fun than working alone. In the recent examination, March 1991, some have benefited enormously from the help and support of fellow students, particularly those who have had to be absent due to illness or domestic problems.
Conclusions There seems to be less pre-examination anxiety amongst the student group because the topics to be examined are known to everyone and have been raised in tutorials and remedial sessions. Those students who find oral examination very difficult to cope with are disadvantaged, but whether this is because they dislike having to talk through their knowledge or because they have only started the learning process a week before the test is sometimes difficult to ascertain. Students who do not know the work are likely to fail, but those who find the style of examination a problem can often redeem themselves by correctly answering spontaneous questions or by explaining another unrelated aspect of the upper limb-these students may achieve pass or borderline marks. From the teacher’s point of view the student involvement and corporate spirit that this enterprise engenders makes the anatomy course a truly enjoyable experience. The students are so pleased with themselves when they have mastered the complex organization of the three-dimensional limb and when they recognize the basic mechanical principles of movement.
Correspondence: Barbara Tyldesley, Senior Lecturer, Department of Occupational Therapy, Liverpool Institute of Higher Education, PO Box 6, Liverpool L16 9JD.
REFERENCES DAVIES, Don (1986) Maximising Examinarion Performance, p. 20 (London, Kegan Paul). ROSENBALJM, P.S. ( 1 973) Peer-mediated Instruction, p. 160 (New York, Columbia University Teacher College Press). TROMBLY, C. ( 1 983), Occupational Therapy for Physical Dysfunction, p. 125 (Baltimore, Williams Wilkins).
375
SHORT COMMUNICATION
Med Teach Downloaded from informahealthcare.com by University of Sydney on 01/04/15 For personal use only.
Anatomy of the upper limb: a partnership in learning and assessment
BARBARA TYLDESLEY, Department of Occupational Therapy, Liverpool Institute of Higher Education, PO Box 6, Liverpool L16 9JD
SUMMARY Specific rehabilitation of the upper limb by the Occupational Therapist requires a sound working knowledge of the anatomy of the pectoral girdle, arm, forearm and hand. To aid the learning process the Liverpool occupational therapy students are given their assessment topics at the beginning of the course. They find a conducive partner with whom to work and practice, and together they prepare for the oral demonstration which forms the assessment test at the end of the second term. Each student completes a questionnaire at the end of the fourth term. This is designed to ascertain how confident the student felt, and how well they retain their anatomical theoty of the upper limb for clinical work.
Introduction Student occupational therapists learn anatomy in the first year of the Occupational Therapy course so that they appreciate the way the body is constructed and how one body segment behaves in respect to another. Anatomy is of paramount importance for the biomechanical approach to occupational therapy. “The biomechanical approach to treatment applies the mechanical principles of kinetics and kinematics to movement of the human body. . . and are appropriate for patients who have problems which directly affect their range of motion, strength, or endurance necessary to perform daily life tasks” (Trombiy, 1983). The mechanics of the joints and muscles of the body, together with the nervous control of these components enable us to move with power, speed and precision but, if these mechanics are disturbed by disease or injury, motor patterns may be altered, joints stiffen and muscles lose their full potential. The learning processes involved in the appreciation of specific anatomical terminology and factual information about the assembly, relationships, attachments of soft tissue includes listening, seeing, doing and experiencing. Elements of each of these
376
Barbara Tyldesley
aspects of learning are incorporated in the delivery and study of the anatomy of the upper limb, with the Oral Assessment test completing the sequence.
Med Teach Downloaded from informahealthcare.com by University of Sydney on 01/04/15 For personal use only.
Teaching, learning and assessment At the beginning of the anatomy course each student receives a ‘work pack‘ containing diagram outlines for use during the overview lectures when diagrams are labelled, extra structures added and relationships explained. Visits to the Department of Human Anatomy at the University allow the three dimensional layering of the soft tissue to be understood and recognized, making it easier for students to explore their own limbs and those of a chosen partner and to identify the palpable areas and the muscles performing specific movements. The work pack also contains functional anatomy exercises which are ‘peer mediated’, introducing the paired students to new learning strategies and encouraging them to discuss and analyse the workings of the upper limb. Peter Rosenbaum (1973) identifies that students working together foster an interactional intensity of learning which he considers engenders mutual cooperation and satisfaction.
The oral anatomy examination Ten topics covering the upper limb are listed for the examination and are given out at the beginning of the course. The aims for the anatomy section of the syllabus are “to encourage the students to handle and look at their own bodies and those of others to familiarise themselves with surface markings, recognition of movement and the relationship between the superficial and deeper structures” (BScOT Syllabus 1989). The examination is designed to test the accuracy of the student’s “demonstration of’ and “knowledge of” the area under discussion and their understanding of the role of the various components of the musculo-skeletal system in the movement patterns of everyday living. It is hoped that the material thus learned will become part of the working vocabulary of the student and the process of post-examination amnesia will be reduced. The students select their own partner and are encouraged to work together to learn, understand and demonstrate palpable structures. This peer teaching and participation satisfies the desire to help others as well as promoting an intrinsic feeling of satisfaction and self esteem. “The overriding consideration in any learning situation is to have a happy and secure emotional ‘climate’ created through satisfying, consistent, harmonious relationships and interesting and meaningful projects” (Davies, 1986). It must be pointed out that despite the comparatively sheltered and cooperative style of learning involved, the actual examination has its own stresses. Many people find that expressing themselves verbally in an examination situation is more difficult than the act of writing similar information. Concentration has to be sustained and the fear of forgetting is greater. In an oral examination the examiner must be constantly mindful of these stresses and assist candidates to perform to the best of their ability by responding in an encouraging way when the candidate is doing well, and by careful questions when certain facts have been omitted.
Presentation of the questionnaire Three cohorts of students have completed the questionnaire at the end of the fourth
Learning anatomy
377
term. It is presented without any forewarning, the contents and aims are explained and the anonymity of all participants emphasized. Most students have been rather taken aback by the prospect of filling it in but have been game to try, and despite the initial expressions of incredulity the results of the questionnaires have been encouraging.
Results
Med Teach Downloaded from informahealthcare.com by University of Sydney on 01/04/15 For personal use only.
Not all the students enjoy this style of learning but most seem to find it more fun than working alone. In the recent examination, March 1991, some have benefited enormously from the help and support of fellow students, particularly those who have had to be absent due to illness or domestic problems.
Conclusions There seems to be less pre-examination anxiety amongst the student group because the topics to be examined are known to everyone and have been raised in tutorials and remedial sessions. Those students who find oral examination very difficult to cope with are disadvantaged, but whether this is because they dislike having to talk through their knowledge or because they have only started the learning process a week before the test is sometimes difficult to ascertain. Students who do not know the work are likely to fail, but those who find the style of examination a problem can often redeem themselves by correctly answering spontaneous questions or by explaining another unrelated aspect of the upper limb-these students may achieve pass or borderline marks. From the teacher’s point of view the student involvement and corporate spirit that this enterprise engenders makes the anatomy course a truly enjoyable experience. The students are so pleased with themselves when they have mastered the complex organization of the three-dimensional limb and when they recognize the basic mechanical principles of movement.
Correspondence: Barbara Tyldesley, Senior Lecturer, Department of Occupational Therapy, Liverpool Institute of Higher Education, PO Box 6, Liverpool L16 9JD.
REFERENCES DAVIES, Don (1986) Maximising Examinarion Performance, p. 20 (London, Kegan Paul). ROSENBALJM, P.S. ( 1 973) Peer-mediated Instruction, p. 160 (New York, Columbia University Teacher College Press). TROMBLY, C. ( 1 983), Occupational Therapy for Physical Dysfunction, p. 125 (Baltimore, Williams Wilkins).
