Above: Katie Brown, a master’s student in biomedical sciences, uses CSU’s new human virtual anatomy program to study the application of virtual reality in cardiology. Photo: John Eisele / Colorado State University

There’s an adage in medical education that the anatomy laboratory is where the dead teach the living. It’s a reference to cadavers – the gold standard for training aspiring medical professionals in the workings of the human body.

The idea of cadaver-based education is startling if you do not wish to be a medical doctor, osteopath, nurse practitioner, dentist, pharmacist, ophthalmologist, physical therapist, occupational therapist, or biomedical researcher. But if you do? Then you must understand how the human body functions in healthy, diseased, and injured states. The best way to learn is to look inside: to see and understand anatomical structures, how they fit within systems – circulatory, digestive, muscular, nervous, respiratory, skeletal – and how, in turn, these systems elegantly interact to generate and sustain life.

Mark Frasier and Tod Clapp
Brain trust: Mark Frasier, left, started Colorado State’s human anatomy classes in 1972 with the goal of building a world-class education program; Tod Clapp, who was one of Frasier’s students, took over the human anatomy program in 2014 and had a lead role in envisioning the Health Education Outreach Center. Photo: Mary Neiberg

Colorado State University hasn’t had a medical school, although a collaborative plan under development will bring a branch of the University of Colorado School of Medicine to the Fort Collins campus in coming months. The branch will draw on CSU’s renowned expertise in life sciences, including its human anatomy and neuroanatomy education programs.

Years before the plan emerged, CSU appealed to scholars pursuing careers in medicine and health care by touting its student-to-cadaver ratio of 4-to-1. Leaders of the University’s human anatomy program compare this ratio to those at the best medical schools worldwide. It is a simple index of opportunities to learn mind-boggling complexities and a rarity for students just starting the path to medical school.

This ratio is the reason Lauren Mahaffey came to CSU from Maryland to earn a master’s degree focused on human anatomy in preparation for medical school.

“It’s amazing as a learning tool,” Mahaffey said of the cadaver learning she has received in her first four human anatomy classes. “I don’t think it’s possible to learn anatomy entirely from a book because it’s 3-D and everyone is different – there are variations in bodies. You need to see all the layers and variations to understand the human body in all its glory.”

The new Health Education Outreach Center encompasses nearly 40,000 square feet of state-of-the-art classroom and laboratory space, representing a new gold standard in health and medical education. Photo: Mary Neiberg

Andrew Auer, who earned a master’s degree focused on human anatomy in 2018, said his preparation at CSU gave him a jump-start on medical school at Creighton University. He has observed other medical students struggling to keep up. “That would have been me without the program at CSU,” Auer said. “It laid the foundation so I’m not constantly in survival mode.”

When Mahaffey started her graduate program last August, she entered a new world in human anatomy and neuroanatomy education. She is among the first students to take classes in the Health Education Outreach Center, a $23.3 million wing of the University’s Anatomy/Zoology Building. The facility fully opened at the start of the 2019-2020 academic year; it adds to a science corridor that has remade the southeast side of campus and includes new Biology and Chemistry Research buildings.

The Health Education Outreach Center, home to the Department of Biomedical Sciences, encompasses nearly 40,000 square feet of state-of-the-art laboratory and classroom space, providing some of the most advanced human anatomy training in the country. Here, more than 800 students annually receive cadaver-based education and, as of this academic year, something more: human virtual anatomy training. The high-tech program, part of a broader CSU virtual reality initiative, is designed to augment traditional cadaver education, allowing students to view and understand the human body like never before.

“The way we approach technology in education is by asking, ‘Does it change outcomes?’” said Tod Clapp, head of CSU’s human anatomy education, who has had a lead role in creating the virtual reality program. “We’re not interested in making things that are simply neat to play with. We want tools that change the way we understand and interact with data.”

Tod Clap and Callie Geier
Tod Clapp, an associate professor in the Department of Biomedical Sciences, confers with Callie Geier, a senior majoring in neuroscience, during a neuroanatomy lab session in Spring 2020. Photo: Mary Neiberg

Industry experts describe the CSU human virtual anatomy program as the largest deployment of virtual reality for medical education anywhere in the world. University faculty designed software used in the program. And students explore three-dimensional computerized anatomy in a laboratory with 100 headsets that dangle from the ceiling; its infrastructure delivers so much data that it must be cooled, much like a server room.

The human virtual anatomy program stands apart for a few reasons. Among them, students may learn in teams, in tandem with other teams, and with the added ability to stream virtual anatomy exercises around the globe – uniquely enabling remote learning.

“If you’ve got 100 people in a class, which is fairly common, they all deserve the opportunity to learn immersively. CSU’s parallel experience is the most efficient way to enable this,” said Paul Martin, HP Inc.’s chief technologist of XR, who helped equip the program. “The CSU program stands alone. I’ve been across the country, and nobody’s doing anything at nearly this scale.”

Mahaffey, the master’s student, described the combination of cadaver and virtual learning as anatomy education greater than the sum of its parts: “It’s two plus two equals a thousand,” she said. “With the 3-D capabilities of the virtual reality, it’s like looking at the body as we imagine it. You can see it, touch it, pull it apart, put it back together. You really get to superimpose the virtual reality over the cadaver learning, so you’re engaging your brain in multiple ways. It’s a remarkable way to understand the human body.”

The virtual reality lab in the Health Education Outreach Center is like a surgical amphitheater for the digital age, a technological gateway to new medical insights and innovations. It has the potential to help revolutionize health education and care, delivering new anatomy visualization tools to the masses, whether elementary students, high schoolers, undergraduates, medical students, practicing physicians, or patients seeking to better understand a personal medical problem or procedure. “We’re going to learn a lot about next-generation solutions by working with places like CSU – to identify what’s not working well so we can fix it and what is working well so we can amplify it,” Martin, with HP, said.

plastic model of a skeleton
A plastic model serves as a reference for anatomy students. Out of respect for donors, the photographs shown here do not include real human specimens. Photo: Mary Neiberg
Students holding virtual reality equipment
The new virtual reality program is an immersive modality that allows students to interact with data and with one other, regardless of location. Visitors from universities and tech companies have traveled from around the globe to see the program in action. Photo: Justin VanAlstyne / JMV Digital

In the nation’s first operating theater, built nearly 220 years ago at Pennsylvania Hospital in Philadelphia, surgeons gave patients three anesthetic options: opium, whiskey, or a wallop to the head. CSU’s virtual reality program allows students to construct, deconstruct, and examine color-coded organs and anatomical systems in three dimensions to understand their places and interdependency in the body – without touching, and certainly without walloping, a real person. With the program, students can virtually dissect a human heart and, like blood, journey into the aorta and on to the body, with the sensation of following the blood’s vital flow.

But this is not a ramped-up video game; it is a new way of seeing and learning. Before, a human neuroanatomy class taught brain structure and function starting with images of two-dimensional cross sections – an approach many undergraduates couldn’t get their heads around. Now, they see that plane relative to the whole virtual organ.

Student wearing virtual reality equipment
CSU’s virtual human anatomy program allows students to manipulate and examine digitally rendered organs and anatomical systems in three dimensions, providing a new way of seeing and learning. Photo: John Eisele / Colorado State University

Even more, virtual reality illustrates dynamic pathways – for instance, how the brain processes vision. “We show it in two dimensions, and students are asked to imagine the three-dimensional pathway,” Clapp said. With the new modality, Clapp can fully illustrate these connections in three dimensions and demonstrate case studies, such as the effect on neurological pathways and vision if an optic nerve is damaged.

Add this to examination of real specimens in the lab, and eureka. In this way, the technology enhances cadaver learning, Clapp said. The concept played out during a recent anatomy class. Students spent an hour in the virtual reality lab, then moved directly into the cadaver laboratory, where they spent two hours comparing the virtual to the real.

Window with dry erase notes behind silhouette of anatomy skeleton
Tintable windows, which double as white boards, often are covered with students' anatomical diagrams - in this case, depicting structures in the human hand. Photo: John Eisele / Colorado State University

Mahaffey and classmate Jacqueline Parker examined an artery in the upper right arm. “We’re trying to figure out – what is this?” Mahaffey said, pointing to the body. “We know because of process of elimination, but because we’ve seen it in VR, it makes more sense. We know exactly where things should be.”

Through the virtual reality program, students explore digitally rendered structures derived from hundreds of anonymous medical images, mainly computed tomography scans and magnetic resonance imaging. In addition, about 20 of Clapp’s friends and colleagues have donated their own medical images because they are so excited to help develop the human virtual anatomy program. Students don’t know it, but they are likely examining the virtual anatomy of some of their professors.

The virtual modality is a notable piece of anatomy education that has been decades in the making at Colorado State. The Health Education Outreach Center is a key resource in CSU plans to host a branch of the CU School of Medicine; the branch will open for its first students in May and will admit its first full cohort of a dozen students in 2021, with possible expansion from there.

The center also is a linchpin in plans to deliver new health outreach programming through Spur, the CSU campus set to open at the National Western Center in Denver in 2022. In fact, the majority of funding for construction of the Health Education Outreach Center came from the University’s budget for the Spur campus – possible because the center will deliver health-related public education tied to the forthcoming Denver campus. The University Facility Fee Advisory Board, a group composed of CSU students, also allocated $1 million in student fees to the project.

Spur offerings will include an expansion of long-standing human anatomy outreach programs: For years, the Department of Biomedical Sciences has annually reached more than 10,000 students through summer anatomy camps and Brain Awareness Week activities in Northern Colorado middle schools and high schools, among other projects. Even now, Clapp and his colleagues are introducing the human virtual anatomy program to students at Frederick High School north of Denver. The CSU team is forming a spinoff company to commercialize the virtual reality program, which will make it widely available for education and investigating data of all kinds in three dimensions.

Students using virtual reality equipment at CSU's immersive reality lab
CSU's new human virtual anatomy program is operating at an unmatched scale, with software designed by University faculty and the ability to stream classes around the world. Photo: John Eisele / Colorado State University

The Health Education Outreach Center, with its leading-edge labs and classrooms, also has allowed an increase in CSU students taking anatomy and neuroanatomy courses. Indeed, the facility is enabling the University to significantly expand the number of students admitted to its high-demand biomedical sciences major, one of several popular academic routes to medical school. But even students who are not bound for med school may take these classes.

“This was the dream – the best in the world,” said Mark Frasier, who started teaching CSU’s first human anatomy classes in 1972 with one cadaver as a reference for 200 students. Frasier, who retired in 2014, described the evolution of anatomy courses while standing in a gleaming new laboratory space, where students may study and compare 36 human cadavers at once.

The fourth-floor lab, with views of the foothills, is fully wired for Internet access and is equipped with details such as flooring to ensure biosafety and expansive windows of tintable electrochromic glass; the windows double as white boards and often are covered with students’ hand-drawn anatomical diagrams. In this lab, complete air exchanges occur every two minutes, improving air quality and almost eliminating odor from preserved human specimens. Medical lamps from France – 37 of them – offer LED lighting needed for close cadaver examination; each is equipped with a camera that can stream high-definition images of focal areas to digital screens across the room or around the world in real time.

Anatomy lab light
Medical lamps include cameras to stream images of cadaver focal areas to screens across the room or around the world, allowing students and instructors to compare and discuss what they're viewing. Photo: John Eisele / Colorado State University
lab equipment hangs in a quiet lab
Laboratory spaces in the new Health Education Outreach Center are outfitted with medical-grade equipment. Photo: Mary Neiberg
Health Education Outreach Center
Students work in teams during a neuroanatomy lab in the Health Education Outreach Center. It is notable as a benchmark facility that combines virtual reality and traditional anatomy education with human specimens. Photo: Mary Neiberg

“This is by far a one-of-a-kind facility. Having human gross anatomy and virtual reality side by side is so unique,” said Jennifer Cordes, project principal with Hord Coplan Macht, the firm that provided planning and design for the Health Education Outreach Center and a national specialist in health care and higher education. “Learning about human anatomy and physiology is important for mankind, and CSU wanted a functional and beautiful space for important science education.”

For all the technology in the new center, Frasier noted, traditional cadaver education imparts essential aspects of medical training and practice – most important, respect and compassion. Before death, people choose to donate their bodies for medical education, and the bodies are accepted and handled by the Colorado State Anatomical Board, based at the CU School of Medicine.

From the first day of class, students gain profound respect for these donations. Cellphones are banned in laboratories, and photographs that could be publicly shared are forbidden. But the rules are hardly needed: Students quickly grasp that working with a preserved body or organ is working with the person who donated it and, by extension, patients who await in the future. Students invariably express gratitude for this incomparable learning.

“Cadavers allow students to use all their sensory equipment – to feel an artery, a vein, a nerve, and to see how that artery is related to the muscle next to it – and then to appreciate their own lives,” Frasier said. “It gives students a connection to life, to death, to people.”

Published in the Spring 2020 issue of Colorado State Magazine