How much anatomy does a nurse need to know? This is a perennial question relating to the design of nursing curricula, and one that I, in teaching anatomy and physiology to student nurses, have been asked frequently by my students. In the United Kingdom we have moved to nurse education curricula that purportedly emphasize a holistic approach to nursing. Therefore, biological sciences dominate less of the curricular content, which incorporates more of other subject areas, including psychology, sociology, and ethics, to mention just some themes. Despite this move, many students (and some teaching and clinical staff) still seem to have a mind-set focused narrowly on the importance of biological sciences to the exclusion of all else. The impression I get from some Internet-mediated nursing discussions is that the situation is not so very different in other countries. Perhaps, then, greater availability of learning resources dealing with anatomy and physiology, which students could access in their own study time, might provide a method for dealing with content that is difficult to include in a crowded curriculum.
The Human Anatomy CDROM program, produced by Gold Standard Multimedia Inc., is designed to allow the study of gross anatomy through the various stages of human dissection, without the need for a dissection laboratory. It contains over 6000 photographic images derived from dissections, with accompanying text. The standard screen layout consists of a text box covering about 45% on the right of the screen, an image box taking up about 25% on the left, and a variety of other small boxes, including navigational tools. Clicking on an image or on the appropriate button will enlarge the photographs to full screen size. According to the developers, this design is intended to overcome the traditional problems of both text-based dissection manuals with little accompanying illustration, and photographic anatomy atlases with little text. It will run, provided one has a CD-ROM drive, on either a PC running Windows 3.1 (80386 processor or better), or a Macintosh with System 7 (see system requirements below). I have only run it on a Macintosh platform (Apple Quadra 650, System 7.1), so I cannot comment on how well the files install and the program runs under Windows.
The program is divided into seven anatomical regions (back and spinal cord, upper extremity, lower extremity, thorax, head and neck, abdomen, and pelvis and perineum), and further subdivided into 44 "dissection laboratories." It can be used in two modes, tutorial or practice practical. In tutorial mode, any of the seven anatomical regional overviews can be accessed by clicking the mouse on that region, and from there a list of laboratories is accessible by clicking on a "hot text" list. Each laboratory contains osteology sections, dissection procedures with photographic images and line drawings, and accompanying explanatory text. Navigation was, generally, simple and straightforward; the only restriction I found was the constrained manner of going to a specific organ from the title screen. For example, if I want to look at the images of the kidney, I have to go through a specific sequence of screens-from the title screen-to get there, rather than having a simple access method using one of two mouse clicks or even typing in a "go to" command.
In practice practical mode, accessible from the title screen or at any time during tutorial mode from the navigation buttons, the user can customize a quiz based on one or more categories within any anatomical region. Using multiple choice format, a score can be generated from the user's answers. I did note one annoying feature in this section: the consistent misspelling of "catagories."
A useful feature on the navigation bar is the "notes" button, which allows the user to make and save notes for future reference or review. Using the Macintosh, these are stored in a new folder created on the hard disk.
Does this program, then, provide for the needs of nursing students? Is it a good example of the use of the potential presented by multimedia facilities? I can envision it being of use to medical students and possibly to students of other "professions allied to medicine," for example physiotherapists, who might need to know detail of human anatomy, but I am not convinced of its use for the majority of nursing students. Whereas it obviously contains a wealth of information and detail, the student would still need guidance in answering the question "How much of this do I need to know?" One also should bear in mind that the program covers only anatomy. There is no discussion of normal physiology or pathophysiology, both areas that many who teach biological sciences to nursing students would suggest are of greater import than anatomy when dealing with patient problems.
There is an emerging ideology that multimedia products should not simply reproduce materials or teaching and learning methods that can be offered in other forms, but should be seeking to offer materials in forms that are not accessible by other media, and should be developing new and innovative teaching and learning methods. However, there is also, for good or ill, an increasing movement to make images and text more widely available and accessible via a variety of electronic means (for example the Visible Human Project and other similar facilities on World Wide Web). This program does seem to fall within the category of simply transferring materials from one medium to another, without any real added advantages; it is a book transferred onto CD. (Although it has the advantage that the student can perhaps use the program for revision at 3:00 in the morning when the dissection laboratory isn't open, the same could apply to a book.)
In terms of image quality and screen layout, the program is very good. However, I cannot see it being of use to many nursing students.
Minimum system requirements (Windows): 80386 processor or better; Windows 3.1 or better; 8-bit color (16-bit recommended); CD-ROM drive; 4 MB RAM; 4.4 MB hard disk space required.
Minimum system requirements (Macintosh): System 7.0 or better; 640 x 480 monitor; 16-bit color; CD-ROM drive; 8MB RAM; no hard disk space required.
Reviewed by
Peter J. Murray