Tools for Improving Embryology Education

Mark J. Holterman, M.D.-Ph.D.

Division of Pediatric Surgery Department of Surgery University of Illinois at Chicago

Embryology is a Foundation Course Mark J. Holterman, M.D.-Ph.D. [email protected]

Embryology is a Foundation Course • A thorough background in embryological principles leads to better understanding of anatomy, and pathophysiology.

• Developmental biologists need to understand the temporal and spatial relationships of the growing and transforming embryonic tissues.

Mark J. Holterman, M.D.-Ph.D. [email protected]

Challenges to Embryology Education • Limited time in medical school curricula • Competition from bigger “more important” courses • Lack of qualified embryology educators • Difficult subject matter Mark J. Holterman, M.D.-Ph.D. [email protected]

Why is embryology such a difficult subject to teach?

• Most students never exposed to embryology • Developmental biology is a dynamic process with multiple simultaneous changes • Microscopic changes happening quickly in the dark • Difficult terminology Mark J. Holterman, M.D.-Ph.D. [email protected]

What can be done to improve embryology learning?

• Increase class room time – Difficult • Prepare better teaching tools – Interactive 3-D models and animations to facilitate active learning • Provide more qualified embryology educators – Distance learning Mark J. Holterman, M.D.-Ph.D. [email protected]

Embryology Teaching Tools: Wish List • 3-D models and animations – Depict dynamic interrelationships • organ systems with simultaneous growth.

– Stereoscopic 3-D representations – Physical models • Interactive capability • Normal and abnormal animations – Clinical correlation Mark J. Holterman, M.D.-Ph.D. [email protected]

Obstacles • Computer graphic artists – Labor intensive and expensive – Artistic license • Embryologists – Lack artisitic skills and experience with computer animation • Surgeons – Lack time and patience Mark J. Holterman, M.D.-Ph.D. [email protected]

Current Directions

Mark J. Holterman, M.D.-Ph.D. [email protected]

Preparation of models and animations • Source: – Carnegie Collection: – National Museum of Health and Medicine • Embryo stages 12-23 – Sectioned, photographed in registry, – Traced, stacked, modeled, • Animations – “Sculpted” between sequential stages Mark J. Holterman, M.D.-Ph.D. [email protected]

Process of modeling and animation Segmentation and Reconstruction Mark J. Holterman, M.D.-Ph.D. [email protected]

Process of modeling and animation 1. The segmented model is opened in 3d Studio MAX Mark J. Holterman, M.D.-Ph.D. [email protected]

Process of modeling and animation 2. A new model is sculpted to smooth out the jagged artifacts from processing. In the following example, the eye is sculpted.

Mark J. Holterman, M.D.-Ph.D. [email protected]

Process of modeling and animation 3. General shape is defined.

Mark J. Holterman, M.D.-Ph.D. [email protected]

Process of modeling and animation 4. The surface is prepare for the refined anatomy.

Mark J. Holterman, M.D.-Ph.D. [email protected]

Process of modeling and animation 5. The refined anatomy is sculpted.

Mark J. Holterman, M.D.-Ph.D. [email protected]

Process of modeling and animation 6. All anatomy is developed in accordance to the original reference material.

Mark J. Holterman, M.D.-Ph.D. [email protected]

Process of modeling and animation 7. Multiple stages are modeled and animated from point to point.

Mark J. Holterman, M.D.-Ph.D. [email protected]

Process of modeling and animation 8. Rendering tests are generated. Animation and anatomy are further refined.

Mark J. Holterman, M.D.-Ph.D. [email protected]

Development of the human face Facial Development Through Stage 18 Mark J. Holterman, M.D.-Ph.D. [email protected]

Ectoderm Development Mark J. Holterman, M.D.-Ph.D. [email protected]

Foregut animations Esophagus and Stomach Development Mark J. Holterman, M.D.-Ph.D. [email protected]

Foregut animations Trachea and Lung Development Mark J. Holterman, M.D.-Ph.D. [email protected]

Foregut animations Liver Development Stage 17-18 Mark J. Holterman, M.D.-Ph.D. [email protected]

Additional animations Mark J. Holterman, M.D.-Ph.D. [email protected]

Embryology Distance Learning • Team teaching of Embryology over the Internet – Experienced embryology educators combining resources and time to teach embryology • Available online course – Realtime or delayed participation – Available website for self study Mark J. Holterman, M.D.-Ph.D. [email protected]

Embryology Distance Learning • Participating educators – Responsibilities: • prepare 1-2 lectures • on-site mentorship for students • submit exam questions – Benefits: • help with teaching tool preparation • help with strengthening course Mark J. Holterman, M.D.-Ph.D. [email protected]

Embryology Distance Learning • Global “Market” for Embryology Distance Learning – medical school – veterinary school – dental school – nursing school – college/high school biology courses Mark J. Holterman, M.D.-Ph.D. [email protected]

New Directions

Mark J. Holterman, M.D.-Ph.D. [email protected]

New Directions • Improved models and animations – MRM/confocal microscopy/optical projection tomography – Computer segmentation – Computer “animation” • Improved visualization tools – Enhanced interactivity • improved graphics cards • visualization software – Stereographic presentation • more affordable than virtual reality Mark J. Holterman, M.D.-Ph.D. [email protected]

3-D visualization using stereographic technology Mark J. Holterman, M.D.-Ph.D. [email protected]

Creation of Physical Models from 3-D data sets Mark J. Holterman, M.D.-Ph.D. [email protected]

Interactive data set management Mark J. Holterman, M.D.-Ph.D. [email protected]

High resolution MRM images Three-dimensional MR image of a developmental-stage-14 human embryo obtained at 750 MHz.

Mark J. Holterman, M.D.-Ph.D. [email protected]

“Embryoscopic” Movies • Endowment for Human Development – Dr Brian Stillwell –

in utero

video of embryo and fetal development – 3-D ultrasound reconstructed “movies” Mark J. Holterman, M.D.-Ph.D. [email protected]

Endowment for Human Development

-in utero

video of embryo and fetal development Mark J. Holterman, M.D.-Ph.D. [email protected]

Endowment for Human Development 3-D ultrasound reconstructed “movies” Mark J. Holterman, M.D.-Ph.D. [email protected]

High tech with an artistic flair • – Alexander Tsiaras, CEO •

From Conception to Birth: A Life Unfolds

– Doubleday 2002 Mark J. Holterman, M.D.-Ph.D. [email protected]

High tech with an artistic flair • MRM of all embryo stages are available • Segment tissues and structures based on gray scale in 3-D space • Add color and transparency for artistic effect and educational impact Mark J. Holterman, M.D.-Ph.D. [email protected]

Anatomical Travelogue : Isolated organ systems Mark J. Holterman, M.D.-Ph.D. [email protected]

Anatomical Travelogue : Isolated organ systems Mark J. Holterman, M.D.-Ph.D. [email protected]

Anatomical Travelogue: Images Mark J. Holterman, M.D.-Ph.D. [email protected]

On the Internet: for mouse embryology • http://bioimaging.caltech.edu/ • http://genex.hgu.mrc.ac.uk/CDROM_online/ cdromIntro.html

• http://genex.hgu.mrc.ac.uk/ Mark J. Holterman, M.D.-Ph.D. [email protected]

On the Internet: Sites with animations • • http://www.indiana.edu/~anat550/cvanim/ http://www.med.upenn.edu/meded/public/berp/ movies.html

• http://anatomy.med.unsw.edu.au/CBL/embryo/ Movies/Movies.htm

• http://www.rchc.rush.edu/embryology/embryolo gy.htm

Mark J. Holterman, M.D.-Ph.D. [email protected]

On the Internet • http://simbryo.stanford.edu/ • Included with Langman’s textbook of embryology Mark J. Holterman, M.D.-Ph.D. [email protected]

On the Internet • http://www.med.unc.edu/ embryo_images/ • This site has the images with a nice teaching tool.

Mark J. Holterman, M.D.-Ph.D. [email protected]

CD-ROM • Gold Standard Multimedia Mark J. Holterman, M.D.-Ph.D. [email protected]

Future Directions

Mark J. Holterman, M.D.-Ph.D. [email protected]

Future Directions • Distance learning initiative – multidimensional teaching tools • “From Conception to Birth Defect” – How abnormal development leads to birth defects • The Child Development Project – depicting changes from birth to five years Mark J. Holterman, M.D.-Ph.D. [email protected]

Acknowledgements • University of Illinois at Chicago – Ai-Xuan Holterman, M.D., Maurice Pescitelli, PhD, Greg Blew, Casey Steffen, Phalguna Langisetty • Medical College of Wisconsin – David Bolender, PhD • Anatomical Travelogue, Inc.

– Alexander Tsiaras Mark J. Holterman, M.D.-Ph.D. [email protected]

Acknowledgements (continued) • Endowment for Human Development – Brian Stillwell M.D.

• Human Developmental Anatomy Center – Elizabeth Lockett, Adrianne Noe, PhD • George Mason University – J. Mark Pullen, PhD • Johns Hopkins University – Chuck Paidas M.D. and Robert Morreale Mark J. Holterman, M.D.-Ph.D. [email protected]

Acknowledgements (continued) • San Diego Super Computer Center – Mike Bailey, PhD • University of Florida – Thomas Mareci, D. Phil • Grant support National Library of Medicine Mark J. Holterman, M.D.-Ph.D. [email protected]

Mark J. Holterman, M.D.-Ph.D. [email protected]

http://www.uic.edu/com/surgery/embryo