DESCRIPTIVE ARTICLE

Postgraduate Fellows as Teaching Assistants in HumanAnatomy: An Experimental Teaching Model at a ChineseResearch University

Xiao Cheng, Lin Wang, Kaihua Guo, Shu Liu, Feng Li, Guoliang Chu, Li-Hua Zhou*

Department of Anatomy, Zhong Shan School of Medicine, Sun Yat-Sen University, Guangzhou,People’s Republic of China

Postgraduate fellowship training programs are expanding at Chinese universities.This growing cadre of advanced trainees calls for the development of new learning andtraining models wherein postgraduate fellows have an ample opportunity to teach morejunior learners, thereby expanding their own knowledge base and competitiveness forfuture employment. Educational reform at Sun Yat-Sen University has recently allowedpostgraduate fellows to act as teaching assistants for undergraduate anatomy courses.This model is common in western countries but is novel in China. Anat Sci Educ 4:29–32.

© 2010 American Association of Anatomists.

Key words: human anatomy; teaching assistant; postgraduate fellowship; Chineseresearch university

INTRODUCTION

Human anatomy is intense subject matter, often overwhelm-ing in its detail and complexity, yet fundamental to professio-nal medical training and practice (Turney, 2007). Anatomistseverywhere face the challenges of making their materialaccessible and relevant to learners (Drake, 1999; Gregoryet al., 2009; Sugand, 2010). At Chinese research universities,anatomy education is further confronted by resource limita-tions that place too many students in demand for too littlespace and very few instructors. Educators are also taskedwith innovating curriculum and cultivating undergraduates’creative and practical skills (Bruce, 1997; Sugand 2010).With the expansion of postgraduate training programs inChina, it is also necessary to develop new learning and train-ing models wherein postgraduate students have an ampleopportunity to teach more junior learners, thereby expanding

their own knowledge base and competitiveness for futureemployment (Meng, 2006).

Educational reform at Sun Yat-Sen University in Guangz-hou, People’s Republic of China, has recently allowed post-graduate fellows to act as teaching assistants for undergraduatecourses, including human anatomy. This model is common inWestern countries but is novel in China. The relationshipbetween postgraduate and undergraduate students is mutuallybeneficial, as the former gain professional teaching experience,and the latter are given opportunities, not previously available,in a more traditional curriculum. We describe here our modelfor employing postgraduate anatomy fellows as teaching assis-tants in an undergraduate medical school anatomy course.

The Role of Human Anatomy PostgraduateFellows as Teaching Assistants

Subjects. Fourth- and fifth-year undergraduate medicalstudents at Sun Yat-Sen University study systemic and regionalanatomy prior to their clinical subjects. These anatomy coursesinclude didactic teaching sessions, led by faculty at the pro-fessor and assistant professor levels, as well as practical small-group sessions facilitated by teaching assistants who havealready earned their Masters or Doctorate degrees and arepursuing advanced training in human anatomy (postgraduatefellows).

Methods. In the undergraduate anatomy courses at ouruniversity, the teaching cadre of six [two faculty instructors,

*Correspondence to: Dr. Li-Hua Zhou, Department of Anatomy,Zhong Shan School of Medicine, Sun Yat-Sen University, No. 74Zhongshan Road 2, Guangzhou 510080, People’s Republic China.E-mail: zhoulih@mail.sysu.edu.cn

Received 5 August 2010; Accepted 7 November 2010.

Published online 8 December 2010 in Wiley Online Library(wileyonlinelibrary.com). DOI 10.1002/ase.193

© 2010 American Association of Anatomists

Anatomical Sciences Education JANUARY/FEBRUARY 2011 Anat Sci Educ 4:29–32 (2011)

two laboratory technicians, and two postgraduate teachingassistants (PGTAs)] divides teaching responsibilities betweendidactic and practical sessions. In preparation for their roleas teaching assistants, all postgraduate fellows in humananatomy participate in a training program conducted by themedical school that aims to hone their skills and make cleartheir responsibilities as teachers. Experienced professors assistthe novices with various teaching skills such as creation oflecture and laboratory illustrations and slides, effective lessonplanning, and classroom time management, and targetingteaching to different learner groups (e.g., clinical vs. forensicvs. rehabilitation medicine students). PGTAs are also coun-seled about dynamic problem solving, identifying students’learning difficulties, and proposing appropriate alternateteaching methods.

The systemic anatomy and regional anatomy coursesinclude 18 sessions (90 contact hours) and 30 sessions (150contact hours), respectively. Each PGTA leads at least six ses-sions (30 contact hours) for each course. All PGTAs areexpected to prepare for their sessions by attending a weeklyconference hosted by the human anatomy department. Suchcollective preparation allows PGTAs to clarify the importantand challenging points of every chapter and lecture topic. Asa group, they can also come to consensus as to which subjectmatter can be briefly summarized for students, and whichtopics should be explained in thorough detail. The conferencesetting gives PGTAs access to experienced professors who canoffer advice when there is doubt or uncertainty in prepping aparticular teaching session. PGTAs are also expected to auditall of the anatomy professors’ didactic courses and maintainfamiliarity with anatomical models and dissected specimens.An additional role for PGTAs is in assessment, includingreviewing examination papers and routinely checking onstudents’ progress and understanding. In short, PGTAs areinvolved in the entire teaching process.

Timing. For most postgraduates in human anatomy at ourinstitution, fellowship training lasts three years. The first yearincludes coursework in anatomic subjects and research studydesign. The second year involves design and execution of aresearch project. The final year is occupied with preparationand defense of a dissertation. In our experience, the timedevoted to research study design in fellows’ second year isalso the best time to teach them about teaching. By this stagein their education, trainees are ready to consolidate theirspecialized knowledge and improve their communicationskills for future careers in academia or industry.

PGTAs Attitude and Approach

Some fellows may approach undergraduate teaching as asimple exercise that draws only on the basic anatomicalknowledge they gained years before, but the practice can bemuch more difficult. When postgraduate fellows serve asteaching assistants and are faced directly with the expectedand unexpected challenges of teaching, they gain skills toadapt and innovate that can be valuable to any future profes-sional situation, inside or outside the classroom (Singh,2010). Undergraduate and graduate coursework provides asolid foundation of knowledge, but teaching a subject bringsits intricacies into sharp relief and requires the teacher to con-nect theory and practice. PGTAs are not so separated fromtheir days as novice undergraduates and thus can organizecomplex topics according to learners’ needs, but with theirdeeper fund of knowledge underlying the lessons.

PGTAs in our program gain most of their teaching experi-ence during the small-group practical sessions. They are alsoexpected, however, to prepare review sessions for each bodyregion as these dissections are performed. Various methods ofrecapitulation are typically used, including diagramming,question-and-answer sessions, and group discussions. PGTAsare challenged to use a variety of summary strategies thataccommodate students’ different learning styles.

Larger Teaching Force Allows for MoreCurricular Innovation

In China just as in other countries, limited numbers ofteachers are faced with large numbers of learners, and thetraditional result has been lecture-based teaching. When thebeauty and wonder of anatomy are confined to lecture slides,students tend to bore and lose motivation. But there are moreexciting and engaging curricular formats that can be appliedto anatomy education. In addition to sharing the teachingload, PGTAs have opened the anatomy courses to curricularinnovation and reform.

As an example from our university, we have found PGTAsto be valuable facilitators of anatomy practical sessionsconducted in the problem-based learning (PBL) format. PBLfocuses on students in the teacher–student dyad and allowsthem to direct the learning process outward from a centralclinical case. Expert teachers must take time to write relevantand level-appropriate case scenarios, but most learning occursas students ask questions about these cases, develop learningobjectives to guide their personal study, and make links toanatomic concepts. PBL curricula have been adopted bymany medical schools in North America and Europe but arerelatively new in China. PBL takes into account four moderninsights into learning. It should be constructive, self-directed,collaborative, and contextual (Kilroy, 2004; Dolmans et al.,2005).

Reciprocal peer teaching (RPT) is another educationalformat that has been introduced to our anatomy courses byvirtue of PGTAs’ presence. The RPT method has studentsalternate roles as teacher and learner and has been appliedwith variable success in several educational arenas (Hen-delman and Boss, 1986; Krych et al., 2005). RPT challengesstudents to perform at the higher level of a teacher and allowsthem to display their thought processes for specific and timelyfeedback. Several hidden benefits of RPT exist for faculty,students, and administration, including reduced need forcadavers, lower operating costs, overcoming anatomy facultyshortages, and lower student-to-teacher ratios (Youdas et al.,2007, 2008; Bentley and Hill, 2009; Singh, 2010).

One method we have found to encourage greater participa-tion and active learning in large-group sessions is team-basedlearning (TBL) (Nieder et al., 2005; Vasan et al., 2008, 2009).Under the tutelage of one professor and two PGTAs, studentswork in teams to answer targeted questions at regular inter-vals throughout the lecture-based learning session. Studentsare expected to prepare before each session, and the benefit tothem is the real-time feedback and guidance they receive asthey apply the lecture content. Most formal lectures have beenreplaced with TBL sessions. Compared with the passive learn-ing associated with traditional lectures, team-based activitiesencourage more student participation that fosters activationof prior knowledge (Haidet et al., 2004; Plendl et al., 2009)and construction of new knowledge (Schmidt et al., 1989;Vasan et al., 2009). PGTAs in human anatomy have facilitated

30 Cheng et al.

the incorporation of various teaching methods with traditionallectures and have fueled students’ positive attitudes and initia-tive in studying anatomy.

PowerPoint and Hand-Painted Anatomy Atlas

PowerPoint slideshows are ubiquitous in medical and under-graduate education. Although multimedia software caneffectively organize large amounts of data and link themwith visual aids, too often students are not prompted to inter-act with the presentations and so are able to easily ignoredetails and thus gain only vague understandings of importantconcepts (Carmichael and Pawlina, 2000). One tool we haveused to augment the passive nature of PowerPoint learning isan anatomy atlas that students paint themselves. In so doing,learners create their own multiplanar visual representationsof certain anatomic structures and regions. For instance, thecauda equina is an often-misunderstood structure where theatlas-painting technique has been helpful. As the studentspaint, it becomes clear to them that there are 31 pairs of dis-tinct spinal nerve roots as opposed to the common miscon-ception that the cauda equina is simply a caudal extension ofthe spinal cord. PGTAs in human anatomy are also involvedin the hand-painted atlas providing instruction, advice, andsupervision to students.

CONCLUSIONS

Postgraduate education is a time for cultivating advancedknowledge and professional skills, and postgraduate traineesrepresent valuable assets and great opportunities for academicinstitutions. Postgraduate fellows operate at the frontiersof academia and are active in research. With appropriatetraining and guidance, these fellows can also make greatcontributions to teaching. The dual priorities of advancingscience through research and preparing the next wave ofinvestigators through teaching are not mutually exclusive butrather synergistic.

As opposed to other postgraduate medical fellowshiptraining programs that may emphasize laboratory research atthe expense of communication and teaching skills, we believeour PGTAs, through their experiences with undergraduateanatomy students, gain more functional knowledge withintheir specialized field, develop stronger organization andpresentation skills, and are ultimately better prepared fortheir careers. They are not only good anatomists but alsogood anatomy educators who can push forward this field inways not yet common at Chinese universities.

NOTES ON CONTRIBUTORS

XIAO CHENG is a Ph.D. candidate in the Department ofAnatomy at Zhongshan School of Medicine, Sun Yat-SenUniversity, Guangzhou, China. She teaches human regionalanatomy and systemic anatomy and guides medical students’dissection learning in a teaching laboratory. Her role in thisstudy was to perform experimental teaching, collect teachingdata, and draft the manuscript.

LIN WANG is a Ph.D. candidate in the Department ofAnatomy at Zhongshan School of Medicine, Sun Yat-SenUniversity, Guangzhou, China. He teaches human regional

anatomy and systemic anatomy and guides medical students’dissection learning in a teaching laboratory. His role in thisstudy was to perform experimental teaching and participatein collection of teaching data.

KAIHUA GUO, Ph.D., is a senior lecturer in the Depart-ment of Anatomy at Zhongshan School of Medicine, SunYat-Sen University, Guangzhou, China. He teaches humanregional anatomy, systemic anatomy, and neuroanatomy. Hisrole in this study was to assist the director of teachingmanagement in developing anatomy curriculum and to providetechnical guidance to Xiao Cheng for her teaching practice.

SHU LIU, Ph.D., is a senior lecturer in the Department ofAnatomy at Zhongshan School of Medicine, Sun Yat-SenUniversity, Guangzhou, China. He teaches human regionalanatomy, systemic anatomy, neuroanatomy, and providedtechnical guidance to Lin Wang for his teaching practice.

FENG LI, Ph.D., is a professor of anatomy in the Depart-ment of Anatomy at Zhongshan School of Medicine, SunYat-Sen University, Guangzhou, China. She teaches humanregional anatomy, systemic anatomy, and neuroanatomy. Herrole in this study and as a senior professor was to direct LinWang’s teaching practice. She also participated in discussionand editing of the manuscript.

GUOLIANG CHU, Ph.D., is an associate professor andthe director of teaching management in the Department ofAnatomy at Zhongshan School of Medicine, Sun Yat-SenUniversity, Guangzhou, China. He teaches human regionalanatomy, systemic anatomy, neuroanatomy, and providesmentoring to junior faculty members and graduate studentsin their teaching. His role in this study was to oversee coursedesign, curricular content for lectures and laboratories, andcollect feedback from medical students.

LI-HUA ZHOU, Ph.D., is a professor in the Departmentof Anatomy at Zhongshan School of Medicine, Sun Yat-SenUniversity, Guangzhou, China. She teaches human regionalanatomy, systemic anatomy, neuroanatomy, and clinicalanatomy. As a senior professor in the department, graduateadvisor to Xiao Cheng and Lin Wang, and principal investi-gator for this project, she was in charge of the general designof the study, defining study goals, structuring the manuscriptdraft, and final editing of the manuscript.

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