93 - The Spatial Understanding of the Omental Bursa: Description of a Teaching Method

Poster Board Number: 93
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Odd poster #s – first hour
Even poster #s – second hour

Co-authors:

Stanley Hamstra, Ph.D. - Professor and Vice-Chair of Clinical Teaching, Department of Surgery, Surgery, University of Toronto

Abstract Body : Introduction

The omental bursa is a space that is contained within the upper abdominal cavity. The omental bursa is difficult to comprehend spatially. Abscess, internal hernia and approach to the pancreas have been related to the clinical applications of the omental bursa. The purpose was to design a teaching method to learn the spatially complex omental bursa.



Methods

1. Conceptualization (box analogy). The omental bursa was compared to a three-dimensional (3D) box as the first step of a spiral learning process. Spiral learning is based on three empirical principles: cyclical learning, increasing depth on each iteration, and learning by building on prior knowledge.

2. Classroom implementation (chalk and blackboard method). A two-dimensional perspective drawing of a box was drawn with a white chalk on a blackboard. The six walls of the box in the standing-up position contained the following structures: roof=liver; back wall=pancreas, left kidney and suprarenal gland; right back corner=inferior vena cava; right wall=opening of the omental bursa; front right corner=duodenum, bile duct, hepatic artery and portal vein; left back corner=splenorenal ligament; left side=spleen; left front corner=gastrosplenic ligament; front wall from top to bottom=lesser omentum, stomach, greater omentum and transverse colon; floor=transverse mesocolon. Direct instruction by a teacher-activator in small interactive group was implemented. The teacher showed all aspects of the box while pretending to enter the opening of the omental bursa within the right wall and then walking on the floor in the standing-up position. The learners were then asked on how to enter the box to explore or perform surgery on the pancreas. The expected answer was to cut the large omentum between the stomach and the transverse colon. The Pringle maneuver to control hepatic bleeding was also shown by compressing the front right corner between the index finger introduced in the opening of the omental bursa and the thumb.

3. Practical applications (cadaveric prosections). The learners were then transferred right after the classroom session to the anatomy laboratory under active supervision to learn the omental bursa on cadaveric prosections with its vestibule, superior and inferior recesses and surrounding structures. The box analogy as prior knowledge was used to learn a deeper 3D knowledge.



Results. Positive feedback has been received informally over a span of 19 years using this teaching method. Next steps are to develop a formal system for collecting, and analyzing feedback from learners.



Conclusion. A teaching method of the spatially complex omental bursa was designed using the principles of spiral learning. When teaching spatially complex anatomy, it might be helpful to make use of spatially-novel teaching methods.