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Reviving out-of-copyright medical illustrations for use in medical curricula

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Clinical Anatomy 00:00–00 (2015) Letter to the Editor Reviving Out-of-Copyright Medical Illustrations for use in Medical Curricula To the Editor, Clinical Anatomy: Amidst medical curricula that are undergoing radical reform, illustrations are both enhanced with regards to clarity and there is concern that anatomy teaching may be inadequate detail, while preserving the original focus. The figure legends for the standards of postgraduate residency programs (Prince and labels were brought up to date with current concepts et al., 2005; Fitzgerald et al., 2008). With the decreasing and terms. number of hours spent in anatomy and embryology laborato- There are no known copyright restrictions for the use of ries (Craig et al., 2010), there also emerges a need for defin- the human cloaca or the forebrain section illustrations in the itive and accessible illustrations for the education of medical United States and Canada as the original books were pub- students. The illustrations contained in modern textbooks lished before 1923 and the authors died [mt]50 years ago. often lack comprehensive detail, and are occasionally in need Furthermore, as per Bridgeman Art Library v. Corel Corp of correction. Moreover, the simplified style of modern medi- (Bangle, 1999), the human cloaca illustration may be not be cal illustration has been described as a desired compromise sufficiently original to merit copyright in the U.S. because it between the professional and initiate (Strong, 2011). is a drawing of a wax model by Keibel. Medical students will often heavily utilize online resources Both images were made available under a Creative Com- provided to them, given the portability of the material and mons licence. Four components of such a license exist, each the ability to utilize it at their own convenience and pace of which must be included or excluded. These are Attributon, (Nieder and Nagy, 2002). There are myriad potential difficul- ShareAlike, Noncommercial, and No Derivative Works. In the ties with copyright in modern medical education, and an case of our images, the former two were stipulated. Attribu- increasing number of institutions have been subject to litiga- tion requires that one must give appropriate credit, provide a tion as a result of unauthorized use of copyrighted materials link to the license, and indicate if changes were made. One in their printed and online modules (Gutman, 2011). We pro- may do so in any reasonable manner, but not in any way pose that modernization efforts involving older, out-of- that suggests the licensor endorses them or their use of the copyright material may represent a viable solution for the material. Share Alike requires that if one remixes, trans- creation of high-quality teaching resources. forms, or builds upon the material, this party must distribute As digital archiving on Internet databases rapidly grows, the new work under the same or similar license as the origi- there has been an unprecedented expansion in the availabil- nal. For instance, we would be unable to apply legal terms ity of scanned out-of-copyright text and illustrations accessi- that restricted others from doing anything the license per- ble online. Consequently, there is an opportunity to utilize mits. Since Noncommercial and No Derivative Works condi- and modify exceptionally-detailed, accurate medical illustra- tions do not apply, one is free to copy and distribute the tions. Here, we attempt to modernize these images for use material in any medium or format, and remix, transform and in contemporary digital databases. build upon the material. This is legitimate for any purpose, Two scanned images were selected for modernization. even commercial. The first, “Cloaca of human embryo from twenty-five to The availability of out-of-copyright materials from vener- twenty-seven days old” from the 1918 edition of Gray’s Anat- ated medical texts represents a unique opportunity to mod- omy (Gray and Lewis, 1918), was downloaded from Wikime- ernize old illustrations while preserving their high level of dia Commons (2014, September 6). The second, “The accuracy and detail. Updating of terminology that has since forebrain section” from the 1920 edition of Ranson’s Anat- changed is feasible and worthwhile in service of the best pos- omy of the Nervous System (Ranson, 1920), was copied sible education in anatomy and embryology. The images con- from the Internet Archive (2010). tained within many anatomy and embryology texts of the Digitally-scanned online versions of the illustrations were early 20th century were painstakingly prepared by physi- compared with hard copies to ensure correct attribution. cians, scientists, and illustrators with an unparalleled appre- Adobe Photoshop CS4 was used to clean up and sharpen the ciation for these domains. source images, as well as remove the original label lines and background to yield an unlabeled base image. Subsequently, *Correspondence to: Adam A. Dmytriw, Department of Medical modernized labels were added, with improved positioning, Neuroscience, Faculty of Medicine, 5850 College Street, Halifax, clearer typeset and lines. In addition, additional hues were NS, B3H 1X5, Canada. E-mail: adam.dmytriw@dal.ca added behind the existing linework to define additional struc- tures. Legends were updated in keeping with changes in ter- Received 25 May 2015; Accepted 28 May 2015 minology and age estimates of embryonic stages. These Published online in Wiley Online Library (wileyonlinelibrary. modernized images are presented (see Figures 1 and 2). The com). DOI: 10.1002/ca.22575 C V 2015 Wiley Periodicals, Inc. 2 Letter to the Editor Fig. 1. “Cloaca of human embryo from 25 to 27 days old.” In its a) original form as published in the 1918 edition of Gray’s Anatomy (left), and b) our modernized version with improved labelling, updated terminology and revised embryo age estimate (right). [Color figure can be viewed in the online issue, which is available at wileyonli- nelibrary.com.] Revitalization efforts for incorporation into medical curric- stating fair use as well as acknowledgments with respect to ula or other teaching resources gives these exceptional reuse of materials in the interest of academic credit (Luo images a chance to be both appreciated for their exceptional et al., 2013). detail and utilized in modern medical education. Moreover, fair use of materials from Internet sources, e.g., Internet Archives, Google Books and Wikimedia Commons (Ganley, Adam A. Dmytriw* 2006), facilitates these efforts. We recommend that when Department of Medical Imaging, endeavouring to update illustrations and images as we have, University of Toronto, 236 McCaul St, that any resource which contains them includes disclaimers Toronto M5T 1W7, Canada Fig. 2. “The forebrain section.” In its c) original form as published in the 1920 edi- tion of Ranson’s The Anatomy of the Nervous System (left), and d) our modernized version with improved labelling and updated terminology (right). [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] Letter to the Editor 3 Meredith. S. Sadler Ganley P. 2006. Google Book Search: Fair use, fair dealing and the Department of Illustration, case for intermediary copying. Fair Dealing and the Case for Intermediary Copying (January 13, 2006). Ontario College of Art and Design University, Gray H, Lewis WH. 1918. Anatomy of the Human Body. Philadelphia, Toronto, Canada PA: Lea & Febiger. Gutman SA. 2011. Copyright in the age of digital scholarship. Am J Paul E. Neumann Occup Therapy 65:123–124. Department of Medical Neuroscience, Luo J, Boland R, Chan CH. 2013. How to use technology in Faculty of Medicine, Dalhousie University, educational innovation. In: The Academic Medicine Handbook. Halifax, Canada New York, NY: Springer. p 117–123. Nieder GL, Nagy F. 2002. Analysis of medical students’ use of Web- based resources for a gross anatomy and embryology course. REFERENCES Clin Anat 15:409–418. Prince KJ, Scherpbier AJ, van Mameren H, Drukker J, van der Bangle P. 1999. Bridgeman Art Library, LTD. v. Corel Corp. Tul J Vleuten CP. 2005. Do students have sufficient knowledge of Technol Intell Prop 1:19–29. clinical anatomy? Med Educ 39:326–332. Craig S, Tait N, Boers D, McAndrew D. 2010. Review of anatomy Ranson SW. 1920. The Anatomy of the Nervous System. education in Australian and New Zealand medical schools. ANZ J Philadelphia, PA: W.B. Saunders Company. Surg 80:212–216. 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