| Description of student roles
Although there were some overlaps, three distinct roles were identified during the interview process which characterized student involvement in the development of the dissection tool. These roles were originator, reviser, and end-user.
The originator was a 3rd year Doctor of Physical Therapy (DPT3) student who selected the topic for the literature review and dissection and led the team of two DPT3 students in planning and conducting the original dissection. The originator had successfully treated a patient with low back pain (LBP) on a prior clinical affiliation, who had presented with signs and symptoms consistent with a dorsal primary (DPR) syndrome. The students worked independently, with minimal guidance from the supervising anatomy instructor, to perform a literature review and the dissection described elsewhere in this manuscript. The originator worked subsequently with the supervising faculty member to develop a step-by-step checklist for the dissection.
The reviser was a DPT3 student who had participated in advanced anatomy coursework and had worked as a teaching assistant in the DPT1 gross anatomy lab. He performed the dissection independently using the checklist created by the originator and photos of the original dissection, with supervising faculty available in the lab for guidance as needed. The reviser then provided feedback and recommendations for changes and additions to the dissection checklist.
The end-user was a 1st year Doctor of Physical Therapy (DPT1) student who had completed the first-year anatomy course and worked as a graduate assistant on some research-related dissections with anatomy faculty. This student was given the revised draft of the dissection checklist, which included more detailed descriptions, and additional photos of the reviser’s dissection. The end-user also received assistance from the anatomy instructor as needed during her dissection. She successfully completed the Basic dissection in two hours, using the revised checklist, photos, and moderate assistance from anatomy faculty. |
| Themes
Interviews from all three students were analyzed with four dominant themes emerging:
(1) The dissection process was very challenging, with the subtheme that the dissection checklist was useful in mitigating the difficulties inherent in the dissection process. All three students indicated that the dissection was difficult because they had not been exposed to the DPR structures in their DPT1 anatomy course. The reviser and the end-user felt, however, that the dissection checklist was very useful and that the opportunity to have explicit photos of the different stages contributed greatly to their successful completion of the dissection.
“When I went through the first year of anatomy courses we were only told to just know that the dorsal primary ramus innervates the erector spinae muscles. We didn’t talk about … the branches and I never heard of the mammilo-accessory ligament before. So these are kind of new concepts and I didn’t have a visual concept in my head of where they were, what they were, and how they went.”— The reviser
“I think that the checklist was helpful… I think the format was really good. It was clear and not too crowded. … The pictures of the dissection that had been done previously … were really helpful”— The end-user
(2) The dissection process of a previously unexplored region had educational value with a subtheme that this dissection is more appropriate for advanced students or those with a strong interest in anatomy. All participants indicated that the dissection had great educational value for students studying anatomy and enhanced their developing knowledge of the evaluation and treatment of patients with LBP. A consistent perspective was that the checklist could be used in basic anatomy courses but would be more appropriate in an advanced course.
“This [dissection] is actually connecting three classes. It’s biomechanics, it’s anatomy, and it’s exam skills … for me this experience has really opened my eyes to regional interdependency”— The reviser
“You don’t really cover those nerves in [first-year] anatomy . . . and you kind of skip over it when you’re doing your dissection . . . [and] it’s kind of hard for a novice dissector to not cut them.”— The originator
“I think it would have been maybe nice to see it [in first year anatomy], but I think with working in a group of six … new students, it would have been difficult to do.”— The end-user
(3) The dissection has clinical relevance with the subtheme of the importance of understanding the structures in the dissection and the relationship to LBP. All participants agreed that the dissection had significant clinical application; and allowed the students to see the anatomical structures that could be the cause of LBP for some patients. They felt that completing the dissection increased their ability to understand the concepts of referred pain and the nuances of the different pain-generating structures in the region.
“I think it’s interesting because for me personally, I love anatomy and I think it’s really important for manual based orthopedic therapy … because you need to understand the anatomy and how it connects. It’s such a complex [process and] … going forward clinically I think I have a tremendously greater understanding of the nerves which was my goal going into this anatomy dissection project. In general, looking at it in the book doesn’t really do it justice until you can really get your hands in there, see it, feel it, and look at it … in 3D.”— The originator
“It could be a tool for introducing the concepts of referred pain. Because … you can actually better appreciate how something up in the spinal column can actually affect and travel down and cause pain elsewhere. And how it’s important to assess where that source of pain could be coming from … [Students] should recognize that hip pain or buttock pain could actually be being caused by something in the back. Do you just look at the buttock? No, you look at the back to clear that. Good PTs clear the lumbar spine first.— The reviser
(4) The process of performing the dissection and helping create this learning tool was exciting and intellectually demanding. All three students expressed that they considered involvement in this project to be a unique opportunity. Their descriptions of their learning processes as they moved through the dissection demonstrated a growing metacognitive awareness.
“I kept telling people about it because … it was so exciting … and I was really happy to do it. I’m especially interested in neurological type things, and so I think being able to see it and actually appreciate how small the nerve and ligament were … Dr. A. kept describing it as ‘the width of two eyelashes’ and it really was. So being able to see … these very small structures … was really beneficial for me.”— The end-user “It was interesting to start with the checklist … distally and working up proximally. I thought that was very helpful for really helping me create a concept map in my head of where the nerves went. Starting from the end and following it all the way back to the beginning. Because I knew where the dorsal root ganglion was, I knew where the spinal nerve was, and I know where the superior cluneal nerves are … But I never saw all these components as a full picture. So that’s what made this dissection different.”— The reviser |
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