DESCRIPTIVE ARTICLE

Body Painting as a Tool in Clinical Anatomy Teaching

Paul G. McMenamin*

School of Anatomy and Human Biology, Faculty of Medicine, Dentistry and Health Sciences,The University of Western Australia, Crawley (Perth), Western Australia, Australia

The teaching of human anatomy has had to respond to significant changes in medicalcurricula, and it behooves anatomists to devise alternative strategies to effectively facili-tate learning of the discipline by medical students in an integrated, applied, relevant, andcontextual framework. In many medical schools, the lack of cadaver dissection as the pri-mary method of learning is driving changes to more varied and novel learning and teach-ing methodologies. The present article describes the introduction and evaluation of arange of body painting exercises in a medical curriculum. Body painting was introducedinto integrated clinical skills teaching sessions which included clinically important aspectsof respiratory system, musculoskeletal system, and topics in regional anatomy includinghead and neck. Nontoxic body paints, easels, a mixture of brush sizes, and anatomicalimages were supplied. Students were allowed between 20 and 40 min to complete bodypainting tasks, in which they were encouraged to alternate between painting and actingas a model. Students were encouraged to use life-like rendering and coloration whereappropriate. Evaluation of these sessions was performed at the end of the semester aspart of a larger evaluation process. The kinesthetic nature and active participation to-gether with the powerful visual images of underlying anatomy appear to contribute tothe value of body painting as a teaching exercise. In addition, it may have the addedbonus of helping break down apprehension regarding peer–peer examination. Somepractical advice on introducing this method of teaching in medical curricula based onthe outcomes of the evaluation is given. On the basis of our experience and student feed-back, we strongly advocate the use of body painting as an adjunct to surface anatomyand clinical skills teaching classes. Anat Sci Ed 1:139–144, 2008. © 2008 American Association of

Anatomists.

Key words: anatomy; body painting; musculoskeletal; live models; evaluation

INTRODUCTION

Dissection of human cadavers, essentially a regional-basedapproach to learning topographical anatomy, is no longerused as the principle method of delivery in a significant num-ber of UK, US, and Australian medical schools (Drake, 2002;Drake et al., 2002; Heylings, 2002; Hanna and Tang, 2005;Turney, 2007). Turney (2007) recently pointed out that one

of the fundamental reasons why anatomy may be in declineis that teachers of the profession have failed to evolve andadapt quickly enough, a point raised many years earlier byAllbrook (1958). Continued pleas, predominantly from sur-geons, for a return to more traditional courses or ‘‘get backto basics’’ (Hanna and Tang, 2005) are unlikely to result ineducational reform (Turney, 2007). Indeed, Turney (2007)recently stated that anatomy is often ‘‘regarded as banausic,archaic, didactic, traditional, overly factual.’’ However, therehave been a number of developments including high-qualitymultimedia programs, such as ‘‘An@tomedia’’ (2002), andother learning aids such as ‘‘The VH Dissector’’ (2005),which allow students to explore anatomical features by digi-tally either removing ‘‘layers’’ or by electronically selectingcross-sectional levels have expanded the tools available toanatomy teachers to aid student learning. Novel uses of thesetechnologies, including projection of anatomical images ontolive models (McLachlan and de Bere, 2004), further extendthe value of other teaching methods in the classroom.

*Correspondence to: Prof. Paul McMenamin, School of Anatomy andHuman Biology, The University of Western Australia, Crawley (Perth)6009, Western Australia, Australia. E-mail: mcmenamin@anhb.uwa.edu.au

Received 25 February 2008; Revised 22 May 2008; Accepted 22 May2008.

Published online 14 July 2008 in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ase.32

© 2008 American Association of Anatomists

Anatomical Sciences Education JULY 2008 Anat Sci Ed 1:139–144 (2008)

Surface or ‘‘living’’ anatomy, which is integral to an under-standing of clinical anatomy, is likely taught in various forms inmany medical anatomy programs (Aggarwal et al., 2006; seereview, McLachlan and Patten, 2006); however, the extent of itsuse is difficult to ascertain, and indeed, it has been omitted inrecent surveys of teaching methodologies (Drake et al., 2002;Heylings, 2002). Surface anatomy often involves students delin-eating anatomical landmarks and features on a volunteer ormodel using marker pens or wax crayons or ‘‘cosmetic’’ pencils.This approach results in a series of complex intersecting linesthat quickly become difficult to interpret and for students toremember. Recently, body painting was described by Op denAkker et al. (2002) as a novel method of improving the effec-tiveness of learning surface anatomy in medical teaching, whichcomplimented the teaching of palpation and auscultation.However, the concept of painting musculature on a live modelas means of illustrating the dynamic nature of anatomy hadbeen described some time earlier by Cody (1995), although itsuse as a teaching tool was not explored.

In the present study, the author describes how the bodypainting method described by (Op den Akker et al., 2002) havebeen extended and introduced into new teaching sessions thatcombine medical anatomy and integrated clinical skills at TheUniversity of Western Australia. The purpose of this report isfirst to illustrate, with some examples, the results of these ses-sions and second to present some early evaluation data.

METHODS

Structure of Body Painting Sessions in theMedical Curriculum

At the University of Western Australia, a systems-based medi-cal curriculum is taught in years one and two of the six-yearundergraduate medical curriculum. In the second semester,year two, the musculoskeletal system, peripheral nervous sys-tem, and central nervous system are studied after all the otherbody systems have been completed. Anatomy is taught duringthis semester via a mixture of lectures, tutorials, and practicalclasses. Practical classes consist of a series of learning activ-ities including surface anatomy, radiology, osteology, histol-ogy, and topographical anatomy, through which studentsrotate approximately every 20 min. In some classes, bodypainting was a learning activity. More recently body paintinghas been introduced into integrated clinical skills teachingsessions. To date, these sessions have included respiratory sys-tem, musculoskeletal system (including hand painting, footpainting), and topics in regional anatomy including head andneck. Participation was encouraged but not compulsory.

Practical Organization

Students were allowed 30–40 min to complete body paintingtasks. Nontoxic body paints, easels, a mixture of brush sizes,and anatomical images were supplied. Students were asked toselect, from a series of anatomical diagrams, a concept orstructure of their choice and then paint this on their col-league. Mixtures of anatomical concepts were tackled by stu-dents. Students were encouraged to alternate between paint-ing and acting as a model. In some integrated clinical skillssessions no diagrams were provided, and students wererequested to use knowledge from previous anatomy sessionsto paint key clinically important anatomical features. Whenanatomical features were being painted, as opposed to con-

cepts (e.g., dermatomes), students were encouraged to uselife-like rendering and coloration.

In these sessions, students are given the choice of workingin single or mixed gender groups. In 2007, Integrated ClinicalSkills Teaching Rooms were completed, and these had a cur-tained area that female students could work behind if theyfelt it necessary. All cultural groups were encouraged, but notforced, to participate. The author did not treat gender andculture as a significant issue, and it never appeared to be anissue on the part of the students. The author’s advice would benot to over emphasize this issue in the mind of the students.

Description of Anatomical Concepts,Topographical Anatomy, and SurfaceProjections that Can Be Taught withthe Aid of Body Painting

The range of anatomical concepts where body painting wasused as a teaching adjunct is included in Table 1. In addition,

Table 1.

Anatomical Features and Concepts Reinforced by Body Paintingin Teaching Sessions

Upper limb Muscles acting on the shoulder joint

Muscles of the arm

Muscles of the forearm

Muscles of the hand

Cubital fossa

Carpal tunnel

Course of nerves of the upper limb andhand and their cutaneous distribution

Vessels of the hand

Dermatomes

Bones and joints of the hand

Head and

neck

Dermatomes (trigeminal)

Distribution of the facial nerve and relation

to parotid gland and duct

Muscles of the face

Arteries and veins of the face and neck

Anterior and posterior triangles of the neck

Thorax Position of the heart and valves

Position of the lungs and pleura

Skeletal and muscular anatomy

Lower limb Femoral triangle

Popliteal fossa

140 McMenamin

Figure 1.

Figure 2.

Figure 3.

Figure 3.

The use of body painting (performed by students) in classes dealing with theanatomy of the hand and face.

Figure 2.

Students using body painting to reinforce clinically relevant anatomy, in thiscase, the boundaries and contents of the cubital fossa.

Figure 1.

Body painting on a model to illustrate the shape, size, lobular arrangement ofthe lungs, and their relation to the pleural recesses.

Anatomical Sciences Education JULY 2008 141

getting students to accurately paint on one another the spe-cific size, positions, and relations of major nerves, vessels,bones, muscles, and tendons reinforces learning about theseanatomical features, but also allows them to correlate thiswith surface anatomy and practice palpation.

Evaluation Process

A short questionnaire on this and other aspects of their learn-ing process was circulated at the end of the teaching semester.The responses were on a five-point Likert scale.

All the students featured in the illustrations have givenpermission for their images to be published. In some classes,formally consented paid models were used as subjects andwere generally prepainted prior to commencement of theclass. The professional models signed a Model Release Form.

RESULTS

Body painting is a very powerful means of illustrating the sur-face projections of viscera (Fig. 1), which has been tradition-ally taught using pens or crayons. Prepainted models or peer-painted students can then be used to reinforce clinical skillssuch as auscultation and taking of pulses and measurement ofblood pressure. Body painting can also be used to teach clini-cally important topics in topographical or regional anatomy(see Table 1), such as the cubital fossa (Fig. 2) and innerva-tion of the hand and face (Fig. 3), femoral triangle, posteriortriangle of neck, etc. In the three years since the introductionof this method of teaching into the medical curriculum at theUniversity of Western Australia, there has been a diminutionin apprehension about upper torso painting and peer–peerinteractions that are critical to the success of these sessions.This change has probably been aided by the completion of

specially designed Integrated Clinical Skills Teaching Rooms,which provide a more professional ‘‘clinical’’ teaching envi-ronment. For example, a curtained area for the use of femalestudents is available if they wish more privacy in these teach-ing sessions. This occurs only occasionally. In general, malesand females intermingle readily during the learning sessionsand are generally very enthusiastic about these teachingsessions. The involvement of clinical skills teachers, pre-dominantly general practitioners, in these programs andthe teaching of the material in a clinical context alongsideanatomy teachers is considered critical to the success of theprogram.

Qualitative and Quantitative Evaluation

In 2004, the practical anatomy session on the hand was thesole session in which body paint was introduced to students.Whilst no formal evaluation was performed, the encouragingresults and positive verbal feedback from the studentsprompted the author to introduce this method more formallyin 2005.

The 2005 Cohort

The 2005 cohort of second-year medical students participatedin hand and face painting during anatomy practical classes,and these sessions were evaluated. Of the 176 medical stu-dents, 97 returned completed questionnaires. The results ofthe evaluation of hand painting and face painting are shownin Table 2.

As can be seen, 73% agreed or strongly agreed that thehand painting was enjoyable and 60% found the face paint-ing enjoyable. Only 6% or 11%, respectively, disagreed orstrongly disagreed with the statement on enjoyment. A size-able proportion was equivocal about the experience. Qualita-

Table 2.

Evaluation of Body Painting Sessions by Medical Students (The 2005 Cohort)

Question % Stronglydisagree

%Disagree

%Neither

%Agree

% Stronglyagree

I found the hand painting sessionenjoyable

3 3 22 51 22

I found the hand painting to be a useful

learning tool

3 13 24 46 13

I found the face painting session

enjoyable

3 8 29 42 18

I found the face painting to be a usefullearning tool

3 12 35 38 10

Table 3.

Evaluation of Body Painting Sessions by Medical Students (Upper Limb, Face, Torso Painting) (The 2007 Cohort)

Question % Stronglydisagree

%Disagree

%Neither

%Agree

% Stronglyagree

I found the body painting in the integrated

clinical skills sessions enjoyable

5 11 19 50 15

I found body painting to be a useful

learning tool

3 11 23 53 11

142 McMenamin

tive observations during the class and the free comments inthe evaluation forms suggested that the fun and enjoyment ofthe exercise was a strong factor in the success of these classes.Around 50–60% agreed that the sessions were a useful learn-ing tool. Around 24–35% seemed undecided on this question,and face painting was thought to be less useful than handpainting. One possible explanation for the large number ofundecided is that the questionnaire may have been deliveredtoo soon after the classes for sufficient reflection to haveoccurred.

The 2007 Cohort

The 2007 cohort, besides participating in hand and facepainting, also used body painting to reinforce other topics(e.g. cubital fossa, lower limb, torso) during ‘‘integrated clini-cal skills sessions’’ that took place in the new facilities. Ofthe 146 in the class, 120 responded. Around 65% found thesessions both enjoyable and a valuable learning tool (Table3), which is slightly higher than the 2005 cohort who hadless extensive use of the method of teaching and who did notuse the method in potentially sensitive body areas such asfemoral triangle and upper torso. The proportion that dis-agreed or were undecided in this cohort was slightly less(~35%) than the 2005 cohort.

Use of Professional Artists and Models

Prepainted models can be used not only to demonstrate a va-riety of anatomical features (Fig. 1) but, for example whenillustrating muscles, the teacher can by instructing the modelto perform particular movements and actions create the illu-sion of muscle shortening and lengthening.

DISCUSSION

A reduction in didactic teaching, factual overload, and assess-ment coupled with increased horizontal and vertical integra-tion of the scientific basis of clinical medicine and prepara-tion for lifelong learning are just some of the curricularchanges having an impact on traditional discipline-basedteaching such as anatomy (Turney, 2007). Inclusion of topicsin medical curricula that are unquestionably important inhealth care delivery such as clinical skills, procedural skills,population health, chronic disease management, indigenousstudies, and personal and professional development (IIME,2002) together with the growing knowledge in the fields ofmolecular biology, immunology, and genetics highlight thedifficulties of maintaining dedicated teaching time for manyof the traditional subjects including anatomy, physiology, andpathology. Several medical schools have sought alternativemethods of teaching topographical anatomy besides conven-tional cadaver dissection. The present, largely descriptive, ar-ticle aimed to illustrate the value of body painting as a teach-ing tool in anatomy. Examples have been chosen to conveythe value of this learning aid in transmitting important ana-tomical concepts to medical undergraduates as a supplementto existing structured prosection-based anatomy sessions orcombined anatomy–clinical skills sessions. The positive evalu-ation, both qualitative and quantitative, by the students ofbody painting as a teaching aid, can likely be attributed to acombination of use of visual and kinesthetic senses and activestudent participation. This contrasts with teaching practicesthat rely on rote memorization or passive learning. Structured

learning activities that involve reasoning are known to posi-tively effect assessment outcomes (Miller et al., 2002; Vason,2003; Van Sint Jan et al., 2003; McMenamin, 2005). Slightdifferences in student evaluations between the two cohorts ofstudents (2005 and 2007) may be due to the use of new spe-cially designed Integrated Clinical Skills Teaching Rooms thatbecame available for teaching to the 2007 cohort. It may alsobe due to a greater level of acceptance as the 2007 cohort ofsecond-year medical students had been introduced to pre-painted models as part of their first year clinical skills classeswhen studying the cardiovascular and respiratory systems.

Whilst previously the author had used traditional markerpens and wax crayons for teaching surface anatomy on vol-unteers or models, the introduction of student participationin body painting not only provides a more memorable visualimage than traditional methods but also has been popular asit a practical, participatory, and active learning experience.(Op den Akker et al., 2002), who first described a method ofpainting detailed realistic images of abdominal and thoracicviscera on the skin of the models or peers, emphasized thatbody painting, in addition to allowing students to gain aninsight into spatial relations or surface projections of the in-ternal viscera, also assisted students to overcome natural reti-cence about professional physical contact in the early years oftheir curriculum. Whilst not formally evaluated in the presentstudy, the author noted a general willingness of most studentsto participate in these sessions; however, further studieswould be required to support this qualitative impression andfurther examine issues of gender, age, and race influences onpeer–peer body painting. The present study extended the useof body painting in medical teaching beyond that describedby Op den Akker et al. (2002) to include nonvisceral bodysystems (such as vascular and musculoskeletal systems) aswell as important anatomical concepts, such as dermatomes.

The use of body painting to assist student learning of clini-cally relevant anatomy has proved to be a positive educa-tional experience for medical students. Its usefulness as anadjunct to other methods of learning human topographicaland clinically relevant anatomy is not restricted to medicalstudents and could easily be translated to the teaching of ana-tomical sciences to other allied health professionals and sci-ence students. Following the introduction of body painting inmedical teaching, it has proven to be a very powerful visualmethod of teaching anatomy to life drawing artists interestedin human form and has also proven useful in illustratinghuman anatomy to members of the public at faculty or uni-versity open days.

ACKNOWLEDGMENTS

The author thanks Ms. Joanna Robertson, Director of KidogoArthouse, Fremantle, Western Australia, for her valuable contri-bution during the teaching of life drawing artists. The author alsothanks Prof. John McLachlan for valuable discussions in the earlyphases of the trials of body painting. Finally, the author acknowl-edges the willingness of all the medical students at The Universityof Western Australia to participate in the classes. The author alsothanks the paid models for their enthusiastic participation.

NOTES ON CONTRIBUTOR

PAUL G. McMENAMIN, B.Sc., Ph.D., M.Sc. (Med. Sci.) is aprofessor of anatomy and an Associate Dean for Teaching

Anatomical Sciences Education JULY 2008 143

and Learning (2004-2007) in the School of Anatomy andHuman Biology, Faculty of Medicine, Dentistry and HealthSciences of the University of Western Australia, Crawley(Perth), Western Australia, Australia.

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