Teaching Anatomy and Pathology using MP3 Audio Tours at the Leiden Museum for Anatomy and Pathology

INTRODUCTION

Anatomy and Pathology are two fields that are an essential part of education in the basic medical sciences. In former times, anatomy was taught to a great extent during the first years of Medical School. The Anatomic Theaters in the sixteenth and seventeenth century are still famous. Dissection sessions on human cadavers remained very popular in the educational program for many years. They give the student a good insight in the body structures in normal as well as pathological situations.

In recent years the Dutch medical curricula have tended to become more integrated and patient oriented.¹ In that process the attention paid to the basic sciences of Anatomy and Pathology has decreased, resulting in less hands-on time for the students. This reduction of hands-on teaching in dissection courses has caused great concern with many faculties.² After all, anatomy is typically one of the things that have to be seen in reality to provide students a well developed three-dimensional insight of organs and structures inside the body.

At the Leiden University Medical Center a brand new building for (bio)medical education has been opened in 2007, which incorporated the former Museum for Anatomy and Pathology . The new museum is a bright and modern two-floor facility. More than 800 specimens of the human body are displayed in five glass cabinets. Each cabinet refers to a phase of life ranging from fetal life to the elderly. Inside the cabinet one panel shows healthy specimens and 7 panels show pathology. The museum also offers examples of diseases and abnormalities, which are rare today and can not be observed in other ways. The arrangement of the topics is based on the system of Underwood.³ Touch screens provide further information about the specimens displayed.

In this study we have developed a method to compensate for the decreasing hands-on teaching in Anatomy and Pathology by using the outstanding collection of the museum. Unfortunately, faculty members do not have enough time to provide small group teaching in the museum. In order to make the existing collection accessible to our students in another way we have developed audio tours. With this modern learning tool students can study specific topics and materials in an individual way without the need of intense faculty support. The technique brings Anatomy and Pathology back to life and, in this respect, we think the Museum for Anatomy can be a very valuable addition to the students’ education.

Definition of an Audio Tour

In an audio tour, a traditional guided tour through a museum is replaced by a voice recorded tour to be listened to on a personal audio device. An audio tour is a collection of audio tracks. Each track refers to a specific specimen in the museum, relevant to the course. In the tracks, a narrator indicates and explains specific details the students have to notice. In case the text contains questions or assignments to be solved by the students, the tour is defined as an interactive tour.

Students use the audio files with their personal audio device. This can be a tape player, portable CD-player, MP3 player, mobile phone, PDA, or laptop computer. With the device they visit the museum at pre-scheduled appointments. The audio tours guide the students through the museum. Audio tours have a highly individual nature. Each user can listen to the audio tracks at his/her own pace and in any sequence desired; they can also repeat or skip specific parts of the tour.

MATERIALS AND METHODS

In this study we have developed audio tours for the first year course “Respiration” and the third year courses “Abdomen” and “Thorax”. These three multidisciplinary courses are coordinated by faculty members of the department of Internal Medicine. Several anatomists and pathologists are involved in the educational activities during these courses.

First the course directors selected several appropriate specimens in the museum. A commentary was developed emphasizing the details of each specimen including educational comments. In the audio tours “Respiration” and “Thorax” several questions were added to the script to be answered by the students while observing the specimens. The answers to the questions were published on Blackboard afterwards. The text was recorded on a digital voice recording device. All audio files were converted to the MP3 format and uploaded to the learning environment module of the specific course. For a summary, see Table 1.

The audio tours were integrated into the course program. Participation of the tour was voluntarily. In the first week of the course the students were invited to download the audio files from the learning environment and to visit the museum at scheduled hours. The course directors referred to the materials from the tour in their concluding lectures at the end of their course. The audio tours “Abdomen” and “Thorax” were evaluated with a short survey for basic evaluation purposes only.

Experiences

No technical problems were encountered in the preparation and administration of the tours. Students were enthusiastic about this teaching method. In total 133 students participated in the tours. Seventy-five percent of the students attending the tour used their own digital audio device. Most of them (80%) used an MP3 player for playing the files, while a few students used a cell phone, iPod or laptop. Most students in our setup (64%) preferred the informative tour, while only 31% of our students liked the interactive tour better. Students clearly stated that they would like to have more audio tours to be offered in other courses as well.

DISCUSSION

Like many other medical schools around the world Leiden possesses a large collection of anatomical and pathological specimens gathered together in a museum and its depots. The main users have always been a small group of faculty and students of Medical Schools. Nowadays the interest from faculty to use the unique specimens in their courses is rapidly increasing. With large numbers of students in a course it is almost impossible to show them all around under guidance of a faculty member. The newly developed audio tour concept responds to the request of visiting the museum without the need of many guides and supervisors. So in a modern curriculum where time spent on Anatomy and Pathology has decreased the use of audio tours in the Museum for Anatomy can bridge the gap.

The concept of the audio tours is not innovative in itself. Major museums around the world use spoken tours along paintings and statues using tape or digital audio devices. Using the audio tours in our Museum for Anatomy and Pathology, however, was quite innovative and not performed before. It created an opportunity to actually integrate the outstanding collection into our curriculum. Until that point the specimens were present but not accessible for students. Therefore the educational value of the experience is the simple fact that using the tours they do study dissected specimens in relation to the educational topics relevant at that moment. For the students it is an exciting and impressive experience which absolutely brings Anatomy and Pathology back to life.

Today’s generation of students is very familiar with modern technologies.⁴ Research shows that medical students have high access to computers, broadband internet connections, mobile phones and memory stick devices and those numbers are increasing every year.⁵ Therefore it is strategically interesting to use students’ personal devices in education. In our study we intentionally worked with the students’ own devices. We anticipated that all students would have an MP3 playing device, but we found that this is not the case. Only 75% used a device they owned, all others used a device from a colleague student or friend. These data are consistent however with other studies in this field.⁵

From our experiences we learned that for a 60 minute museum session an audio tour with about 20 minutes of spoken text and about 10 to 15 specimens is appropriate. It has to be realized that students have to find their way around the museum and that they must find the right specimen. Some students also might like to repeat some tracks for a better understanding. For a teacher the development of 20 minutes of spoken text takes about 2 hours of preparation. This includes orientation on the specimens, script writing and recording. The audio tour can be used for several years as long as the content of the course and the collection in the museum do not change.

Audio tours are easy to create. A voice recorder, a microphone and a sound editor are needed. This equipment is not very expensive and free editing software is available. We used an Olympus WS-320M digital voice recorder and the Audacity® Software (open source software). For recording the tracks a quiet environment is recommended to avoid background noise. In our museum the air-conditioning system generated too much noise to make good recordings. We changed to a silent office room to record. To help faculty to create audio tours themselves, a Twelve Tips checklist has been developed.

Audio tours are not meant to replace other educational instruments like dissection room, anatomical lessons and practical sessions, but are to be regarded as a complementary teaching instrument. Dissection of the human body still remains one of the most powerful means of learning anatomy, but is from an educational point of view a very complex process.⁶ Audio tours are less complex and offer a much more standardized educational instrument.

Educational integration and timing of the tour in the course are important. Like with all other learning tools, the goals of using audio tours have to be well defined. To enhance the learning effect of the audio tour, teachers need to refer to the materials during their lectures. But if the tour is offered too early in the course the level of understanding might be insufficient. Finally it might be considered to assess the information from the tour in the concluding examinations by adding questions about several specimens from the tour.

Audio tours like we use in our museum can also be enriched with images to be delivered on iPod equipment. The Royal Veterinary College in London, UK has experiences with that technique.^7-9 Adding images of the anatomical specimens makes it easier to find the right specimen in the museum, which is one of the issues in our museum. Also specific structures in the image can be illuminated for better understanding of the audio. However not all students will have access to iPod equipment. If high device specifications like the graphic capabilities of an iPod are required, the institution has to consider providing the equipment to the students.

FUTURE DIRECTIONS

Audio tours will be developed for more courses in Medicine and Biomedical Sciences at the Leiden University Medical Center. Several are already under construction. For specific groups like guests of the Medical Center or the general public a general tour has been developed. This opens a way to display the scientific resources of the museum to a broader audience. For these guests of the museum centrally managed audio devices with pre-loaded tours are available.

CONCLUSION

Audio tours through the Museum for Anatomy and Pathology can be used effectively in the medical curriculum. The MP3 technology is easy to use and no problems were encountered in developing or performing the tours. The audio tours are highly appreciated by the students. It offers them the unique opportunity to view scientifically and educationally invaluable specimens related to their actual basic science education. Students indicate that they would like audio tours to be offered in other courses as well. Audio tours provide the faculty an opportunity to use the interesting materials in the museum to partly compensate for the decreasing time available for Anatomy.

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