Rethinking the traditional male-first organization of A&P.
In my earlier post, The A&P Textbook You May Have Overlooked, I mentioned that in our revised 12th Edition of Anatomy & Physiology, we turned our story of the human reproductive systems inside out, upside down, and flipped around.
Here's what I meant.
In the 11th Edition of Anatomy & Physiology, our organization probably looked very familiar:
Chapter 45: Male Reproductive System
Chapter 46: Female Reproductive System
Chapter 47: Growth, Development, & Aging
That's also the traditional organization in many A&P textbooks and curriculum documents. The currently posted HAPS A&P Learning Outcomes, for example, list male reproductive anatomy before female reproductive anatomy, followed by spermatogenesis before oogenesis. Of course, the HAPS Learning Outcomes are not intended to prescribe a teaching sequence.
The same male-first convention remains in the other major A&P textbooks we examined. Current examples from Saladin, Tortora, and OpenStax all begin their reproductive-system coverage with the male system before moving to the female system.
So why did we decide to change it?
We didn’t simply reverse the old chapters. We changed the way the reproductive story is organized.
The old story made sense
We had a legitimate pedagogical reason for our traditional organization.
We regarded the typical male genital system as the structurally simpler of the two systems. Starting there allowed students to establish some basic structural principles before moving to the more complex typical female system.
And because the story then moved toward fertilization, gestation, and birth, having the female system immediately precede that content also seemed logical.
I still think those are reasonable arguments.
But we eventually had to ask ourselves how much of our reasoning came from pedagogy and how much came from that very powerful force in education:
That's the way we've always done it.
We were also hearing concerns from professors, students, and others that routinely starting with the male system can carry an unintended message. It can suggest that male anatomy is the starting point or standard, with female anatomy following as a variation on that story.
That certainly wasn't the message we intended.
But intent isn't the only thing that matters in telling a story.
We weren't the only ones thinking about this
Once we began looking into the issue, we found that scholars had been raising related concerns for decades.
In 1992, Susan Lawrence and Kae Bendixen examined 31 anatomy textbooks used by U.S. medical students from 1890 through 1989. They found that illustrations, vocabulary, and syntax commonly presented male anatomy as the norm or standard against which female anatomy was compared.
Susan Morgan and colleagues later examined contemporary anatomy textbooks. They likewise found problems with equal representation of female and male anatomy. Interestingly, their research with medical students suggested that many students did not recognize some of these issues themselves.
Then, in 2021, Katherine Ray King, Linda Fuselier, and Harshini Sirvisetty analyzed four widely adopted undergraduate nursing A&P textbooks. They specifically described a "male-first" perspective in which males occupy the central position and female and nonbinary identities become the "other."
Elizabeth Whitaker and Raffaella Baccolini looked at a different setting—Italian middle-school science resources—but found the same ordering convention. All the books they examined followed a male-first sequence when presenting reproductive topics.
These studies don't all examine the same learners, the same kinds of textbooks, or the same issue in exactly the same way. So I don't want to stretch their findings beyond what they actually show.
But they did reassure us that we hadn't rocketed off to an entirely new planet by questioning the traditional sequence.
There really is something worth thinking about here.
Just flipping the chapters wasn't enough
The obvious solution would be easy:
Chapter 45: Female Reproductive System
Chapter 46: Male Reproductive System
Done!
Except we didn't like that solution very much.
It would still make one system the starting point and the other the follow-up. It wouldn't really rethink the story. It would simply reverse it.
We wanted to organize these topics around something other than male versus female.
And we had another important consideration.
As I've explained previously [Chunking Chapters—By The Numbers], we've deliberately divided our A&P story into relatively small chapters. In our comparisons, our chapters average about half the size of those in many other undergraduate A&P textbooks.
We think that kind of chunking makes a huge body of unfamiliar information more manageable for beginning learners.
So we wanted to keep three relatively small chapters. We didn't want to solve one problem by creating one or two monster chapters on reproduction.
Yeah, it took us a while to figure this out.
The Patton Team discussed and debated the reorganization for several years. A change this large unravels all kinds of other things in a textbook—figures, tables, review questions, online resources, cross-references, and much more. And the limited amount of time between editions is a very real factor in deciding whether a major change can actually be accomplished.
We also weren't yet sure where our A&P colleagues and students wanted this story to go.
Eventually, two familiar ideas came together and gave us our solution.
Structure first, then function
When we've divided larger chapters into smaller chunks in previous editions, one approach that has often worked well is a structure/function split.
We aren't alone in finding that sequence useful. Even within the larger chapters of other A&P textbooks, it's common to establish important anatomical structures before moving more deeply into the physiological processes involving them. You can see versions of that pattern throughout A&P—for example, respiratory anatomy before pulmonary ventilation, or kidney anatomy and histology before renal physiology.
Of course, anatomy and physiology ultimately belong together. Many of us quite rightly say that we integrate structure and function in our teaching.
But to integrate things, students first need some things to integrate.
At some point, a beginning learner needs a reasonably clear picture of the structures involved and a reasonably clear picture of the processes involving those structures. Then the connections between them can become richer and more useful.
That familiar structure/function approach gave us one part of our solution.
The other part came from terminology.
Genital or reproductive?
We had been noticing increasing use of genital system, especially when the emphasis is on anatomy.
And that term has a solid anatomical pedigree.
Terminologia Anatomica, the international standard for human anatomical terminology, calls its Chapter 9 Genital Systems. It lists the Female Genital System first, followed by the Male Genital System. It also recognizes female reproductive system and male reproductive system as synonymous terminology.
Now, Terminologia Anatomica is a terminology standard, not an A&P curriculum guide. Its ordering doesn't tell us how to teach.
But the terminology helped us see an elegant way forward.
We didn't want to abandon reproductive system, either. That's the familiar term that our students will continue to encounter in courses, learning outcomes, clinical settings, and other textbooks.
So we explain that the terms can be used interchangeably. But in our own narrative, we tend to use genital when we're emphasizing the structures and their basic functional anatomy. We tend to use reproductive when we're emphasizing the physiological processes involved in producing offspring.
And there it was.
Instead of dividing our chapters into male and female, we could divide them largely into structure and reproductive function.
And within each part of the story, we could use a female-first sequence.
The goal wasn't to declare female anatomy the new "default." The more important change was getting rid of sex as the dividing line between the chapters.
Act 1: Genital Systems
Our new Chapter 45: Genital Systems establishes the structures and their basic functional anatomy.
And yes, we flip the traditional sequence. We begin with the typical female genital system.
Here's the first half of the program:
Chapter 45: Genital Systems—Typical Female Genital System
Overview of the Genital Systems
Overview of the Typical Female Genital System
Ovaries
Uterine Tubes
Uterus
Vagina
Vulva
Breasts
Within those sections, students explore location, structure, microscopic anatomy where appropriate, and basic functions.
Then we move to:
Chapter 45: Genital Systems—Typical Male Genital System
Overview of the Typical Male Genital System
Testes
Epididymis
Vas Deferens
Ejaculatory Ducts
Urethra
Accessory Genital Glands
Supporting Structures
Composition and Course of Seminal Fluid
Differentiation and Development of Genital Organs
Notice that we haven't simply reversed two chapter titles.
We've brought the anatomy of both genital systems together into one chapter.
That lets students encounter them as related variations on the same basic biological story. It also makes their similarities, differences, and developmental relationships easier to connect.
Act 2: Reproduction
Once students know the structures and their basic functions, Chapter 46: Reproduction moves more deeply into reproductive physiology.
Again, we begin with female functions.
Here's that program:
Chapter 46: Reproduction
Overview of Reproductive Physiology
Female Reproductive Physiology
Female Reproductive Cycles
Recurring Cycles
Control of Female Reproductive Cycles
Importance of Female Reproductive Cycles
Menarche and Menopause
Male Reproductive Physiology
Hormonal Regulation
Male Fertility
Sex Cell Production and Fertilization
Production of Sex Cells
Fertilization
Infertility
I really like the way this story now unfolds.
We first explore female reproductive physiology and its recurring cycles. Then we explore male reproductive physiology.
Finally, those two threads come together as we explore sex-cell production, fertilization, and infertility.
Instead of telling two mostly separate stories called Male and Female, we are telling one reproductive story involving both systems.
Act 3: The whole life cycle
After fertilization, the story flows naturally into Chapter 47: Growth, Development, & Aging.
Here's the program:
Chapter 47: Growth, Development, & Aging
Prenatal Period
Cleavage and Implantation
Placenta
Periods of Development
Stem Cells
Formation of Primary Germ Layers
Histogenesis and Organogenesis
Birth
Stages of Labor
Multiple Births
Postnatal Period
Growth, Development, and Aging
Infancy
Childhood
Adolescence and Adulthood
Older Adulthood
Aging
Mechanisms of Aging
Effects of Aging
Causes of Death
So our three-chapter story now has a pretty simple logic:
Chapter 45: What are the genital structures, and what do they do?
Chapter 46: How do the two systems function in reproduction?
Chapter 47: How do offspring develop, grow, and age?
To us, that turned out to be a cleaner and more logical story than the one we started with.
It preserves our short-chapter approach. It uses a familiar structure/function progression. It keeps all the traditional reproductive content that A&P instructors expect. And it no longer requires maleness to be the automatic starting point for telling the story.
But do I have to reorganize my course?
Nope.
We believe this new organization responds to perspectives we're increasingly hearing from our colleagues and students while retaining the familiar content expected in an undergraduate A&P course.
If you're moving from our 11th Edition to the 12th Edition of Anatomy & Physiology, I think you'll find it relatively straightforward to rearrange your course content to follow the new sequence.
But you don't have to.
All the familiar content is still there.
You may decide that your own course works best with topics in another sequence. There's nothing wrong with students encountering material in one order during class and another order in their textbook. Seeing relationships from more than one direction may even help students develop a more flexible conceptual framework.
The same is true if you're moving to our book from another A&P textbook.
We didn't reorganize these chapters to tell you how you must teach reproduction.
We reorganized them because, after several years of thinking, researching, discussing, arguing, rearranging, and rearranging again, this is the clearest and most coherent way we found to tell the story.
There's more to the reproductive story
Reorganizing three chapters wasn't the only thing we changed.
We also took a fresh look at some of the most challenging reproductive concepts to explain and illustrate clearly for beginning A&P students.
One of the biggest examples is the ovary. How do we portray ovarian follicles simply enough for a beginning learner, realistically enough to avoid teaching something that isn't really there, and dynamically enough to convey that ovarian function is cyclical?
Yeah. We spent some time on that one.
I'll show you what we came up with in my next post.
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