Original Publication
Open Access

Bare Bones: A Return to Anatomy for Teaching Bone Marrow Biopsy and Aspirate Procedures

Published: May 13, 2015 | 10.15766/mep_2374-8265.10091

Included in this publication:

  • Instructor's Guide.docx
  • Bone Marrow Presentation.pptx
  • Bare Bones Module folder

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. This publication includes large downloadable files. If you experience difficulty downloading these files, please contact mededportal@aamc.org to receive a free DVD version via mail.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: This resource combines a variety of teaching tools to supplement bedside supervised teaching of the bone marrow aspirate and biopsy procedure with an emphasis on underlying deep anatomy. Methods: This resources provides a video with a visualization exercise using live participants, cadavers, and skeletons to teach underlying anatomy involved in performing bone marrow procedures, in addition to a review of technical procedure-techniques. Also included is a PowerPoint presentation developed to address indications, contraindications, and risks of bone marrow procedures that can be used at a clinical teaching session. Results: At pretest, 48% (15 out of 31) of residents landmarked accurately. At posttest, 74% (23 out of 31) of residents accurately performed the procedure. McNemar’s test revealed a non-significant trend towards increased performance at posttest. A Wilcoxon signed-rank test demonstrates a significant difference between pre and posttest accuracy in the 16 residents initially inaccurate at pretest. No association was detected between participant demographics and pretest accuracy. Discussion: Our study suggests that this anatomy-based video exercise improved resident procedural performance as measured by landmarking accuracy. Future research is needed to explore application of this form of intervention on teaching medical procedures. Using this easily-accessed intervention at point-of-care in programs would enhance its impact beyond that realized from our single teaching session.

Educational Objectives

By the end of the module, the learner will be able to:

  1. Engage in visualization exercise of anatomy involved in performing a bone marrow procedure.
  2. Review positioning and landmarking.
  3. Explain elements of obtaining informed consent.
  4. Review procedural techniques involved in cleaning, draping, freezing, and performing aspirate and biopsy.
  5. Explore deeper anatomy through dissection of posterior superior iliac spine.
  6. Review indications for a bone marrow procedure and understand the variety of information obtained from this procedure.
  7. Recognize contraindications.
  8. Describe consent process.
  9. List and discuss adverse events, challenging patients, and how to troubleshoot.
  10. Apply knowledge to cases.

Author Information

  • Michelle Zeller, MD: McMaster University Michael G. DeGroote School of Medicine
  • Mark Goldszmidt, MD: Schulich School of Medicine and Dentistry Western University
  • Sayra Cristancho, PhD: Schulich School of Medicine and Dentistry Western University
  • Marjorie Johnson, PhD: Schulich School of Medicine and Dentistry Western University
  • David Creces: Schulich School of Medicine and Dentistry Western University
  • Joy Mangel, MD: Schulich School of Medicine and Dentistry Western University

None to report.

None to report.


Zeller M, Goldszmidt M, Cristancho S, Johnson M, Creces D, Mangel J. Bare bones: a return to anatomy for teaching bone marrow biopsy and aspirate procedures. MedEdPORTAL. 2015;11:10091. https://doi.org/10.15766/mep_2374-8265.10091