Instructor Companion · Overview

This companion is written for someone who has taught this course before, knows exactly where it goes wrong, and has about forty minutes to decide whether a new book is worth the disruption. So the short version first.

This is a free, CC BY-SA 4.0, two-semester human anatomy and physiology textbook of about 980,000 words across 33 chapters. It is built for the mixed section you actually teach — nursing and allied health, pre-med and pre-PA, kinesiology and exercise science, dental hygiene, EMT and paramedic students, and PT/OT prerequisite students, sitting in the same room with genuinely different needs. It has no images, and it says so on the first page. It has a running clinical case that spans all 33 chapters and is the reason to adopt it. You may print it, edit it, reorder it, translate it, and sell your printed version, provided you attribute and keep the license open.

The rest of this page tells you what you are getting, what you are not getting, and what your students will already have in hand before they walk into your lecture.

Who the book is for, and what that costs

Most A&P texts are written for the nursing student and then have a kinesiology paragraph bolted on. That is a defensible commercial decision and a bad pedagogical one, because in a typical section the pre-health majors and the movement-science majors are close to evenly split, and they need the same physiology at different pressures.

This book resolves that by writing two parallel clinical literatures into every chapter: a Clinical Connection sidebar set that uses disease to expose mechanism, and an Exercise & Sport sidebar set that uses maximal load to expose the same mechanism from the other side. Neither is decorative. The Exercise & Sport sidebars are written at the same technical level as the clinical ones — VO₂max limitation, motor unit recruitment order, substrate crossover, sweat sodium and heat illness — because half your room will be professionally responsible for that material and the other half will be examined on the physiology it illustrates.

The cost of this decision is length. There is more book here than any one course covers. That is deliberate and it is managed by Learning Paths, which gives six curated routes with explicit core, supporting, and skip designations. Assign a path in your syllabus on day one. Students who are told "read everything" in a 350,000-word book read nothing well.

The four things this book does differently

1 · Clinical connections in every chapter, used as evidence rather than as decoration. The editorial rule is that a pathology earns its place only if it explains the normal mechanism. Hypoparathyroidism after thyroidectomy is in Chapter 16 not because your students need to manage it but because a patient whose hands cramp into carpal spasm six hours post-op is the cleanest available demonstration that parathyroid hormone defends ionized calcium minute to minute. You can lift these sidebars directly into lecture as worked examples; they are built to survive that use.

2 · Systems integration as a first-class structural idea. This is the differentiator that matters. One fictional patient, Amara Osei, 45, a night-shift charge nurse, presents in Chapter 1 with chest pressure and runs through all 33 chapters: metabolic syndrome, coronary disease, NSTEMI, heart failure with preserved ejection fraction, stage 3 chronic kidney disease, rehabilitation. Three family members carry the exercise, musculoskeletal, and aging threads. Every chapter ends with a short student-written entry that must connect the new system to at least two systems already covered, stating the direction of causation. See The Systems Integration Case File for the student-facing version and Case File Project Rubrics for the assessment instrument.

3 · Exercise and sport at equal rigor. Described above. Practically: if you teach a kinesiology-heavy section, the Exercise & Sport sidebars read as a continuous short course in exercise physiology and can be assigned as such.

4 · A case study opens every chapter and is fully resolved by its end. The opener gives a specific patient with real numbers and ends with exactly three questions the student cannot answer yet. The resolution section answers all three completely, using only material from that chapter and earlier ones. If a resolution ever requires material the student has not been given, that is a defect and we want the report — see Contributing and Errata.

These four commitments are not marketing. They are constraints the manuscript is validated against, and scripts/validate.py fails a chapter that violates the structural ones.

What your students already have

Do not spend lecture time delivering what the book already delivers well. Here is the fixed architecture of every chapter, in order, with a note on what it frees you to do.

   DIVISION OF LABOR — what the book does, what you should do

   THE BOOK DOES WELL                    YOU DO BETTER THAN THE BOOK
   ─────────────────────────────         ─────────────────────────────────────
   First exposure to vocabulary   ──►    Deciding what NOT to cover
   Complete causal chains         ──►    Running one chain live, with errors
   Normal values with units       ──►    Reacting to a wrong student answer
   Worked clinical examples       ──►    Cold-calling a prediction
   Answer reveals for self-test   ──►    Making students commit in public
   Structural completeness        ──►    Emphasis, priority, and warning
   Figures described in prose     ──►    Anything 3-dimensional or in motion
   ─────────────────────────────         ─────────────────────────────────────
        ▼                                          ▼
   ASSIGN IT. Do not deliver it.          SPEND CLASS TIME HERE.
        ╰──────────────► the 25-minute pre-read protocol in
                         "How to Use This Book" makes lecture a SECOND pass

The three threads, and how to use them out loud

Three ideas recur in every chapter, tagged explicitly with Thread callouts and recapped in every Chapter Summary:

1. Structure determines function. The shape of a structure is a physical claim about its job, so anatomy is predictive.
2. Homeostasis is the master concept. Every system defends a narrow set of variables; disease is homeostasis disrupted and treatment is homeostasis restored.
3. The body is integrated. No system works alone; the connections matter as much as the parts.

The threads are worth almost nothing as slogans and a great deal as reusable lecture moves. Concretely:

• Thread 1 as a prediction game. Before you show a structure, show its constraints and ask what shape it must have. "This tube is 2.5 cm across and 6 m long, material passes through in four hours, and essentially every nutrient must be absorbed. Design the lining." Students who generate villi themselves do not forget villi. Do this three times a semester and they start doing it unprompted.
• Thread 2 as a diagnostic template. Put the five-box loop — stimulus, receptor, control center, effector, response — on the board once in week one and then never redraw it; point at it. For any new pathology ask: which box failed? Type 1 diabetes is an effector failure. Type 2 is a target-tissue response failure. Central diabetes insipidus is a control-center failure. Nephrogenic is again a target failure. Fever is not a failure at all — it is a deliberately moved set point, which is the single most clarifying sentence in Chapter 1.
• Thread 3 as a standing question. End every lecture with the same sentence: "Name one other system this changes, and say which direction the causation runs." Thirty seconds, no slides, and it rehearses precisely what the Case File project grades.

If you adopt nothing else from this companion, adopt the five-box loop and the closing question. They cost nothing and they are the two moves the book is engineered to reward.

The six sidebar types, and which to assign

Sidebars are typed so you can assign them selectively. Telling a class "read the Clinical Connections and skip Development this week" is a legitimate and useful instruction, and the typography supports it.

The sidebar-diet table in Learning Paths gives the same guidance in per-program form and can be pasted into a syllabus verbatim.

What is deliberately not in this book

Being explicit about this saves you a surprise in week three.

There are no images. Not "few" — none. Every figure in this book is an ASCII or box-drawing diagram inside a code fence, followed by a caption and a required Described paragraph that renders the same information in prose. This is a real limitation and you should plan around it. It is also a deliberate trade, and the reasoning is worth having in hand when a student asks:

• A diagram that can be rendered in prose is a diagram whose information content has been identified. The described paragraphs are frequently the clearest explanation on the page, and writing one is itself an excellent comprehension test — which is why several Review activities ask students to write their own.
• Every described paragraph is screen-reader accessible and prints on a black-and-white photocopier, which is what a student who cannot afford a book is actually holding.
• Licensed anatomical art is the single largest cost and the largest legal encumbrance in an open textbook. Refusing it is what makes the whole book genuinely, permanently free.

Pair the book with free image resources and your own slides. In practice this works, and most adopters do some version of the following: your existing lecture slides carry the figures; the book carries the mechanism, the numbers, and the clinical reasoning. Freely licensed anatomical imagery is available from open-access A&P texts under compatible CC licenses, from public-domain classical atlas plates, from open histology slide collections maintained by university medical schools, and from institutional radiology teaching files that permit educational reuse. Check the specific license on anything you redistribute — a CC BY-NC image cannot be embedded in a CC BY-SA derivative of this book, though you may of course show it in a lecture.

There is no proprietary online homework system, and no publisher lockout. No access code, no expiring license, no auto-graded platform bundled with the purchase, and no situation in which a student who bought the book used cannot submit homework. The corresponding cost is that auto-graded homework is your problem: the Review sections are self-scoring by design (the answers are visible in the file), so they cannot be used as secure graded work. The Assessment Bank exists for exactly that reason and provides items that are not in the student text.

There is no test-bank exclusivity. Everything in this companion is under the same open license. That means your colleagues at other institutions have the same items. Treat the Assessment Bank as a source of models and stems to modify rather than as a secure vault, and see the item-writing section there for how to alter an item without destroying its discriminating power.

Adopting it: the license in practical language

The book is licensed CC BY-SA 4.0. In terms that matter to a department:

• You may print it and distribute the printout to your students, and you may charge for the printing. Campus print shops and print-on-demand services both work; a two-semester perfect-bound printing typically lands under twenty dollars a copy.
• You may edit it. Delete chapters, reorder them, rewrite a section you disagree with, swap in your own figures, localize the lab values, or replace the case family entirely.
• You may build a course pack that mixes chapters of this book with other openly licensed material, subject to license compatibility (CC BY and public-domain material combine freely; CC BY-NC and CC BY-ND material cannot be merged into a ShareAlike derivative).
• You may sell your version. Commercial use is permitted.
• You must attribute the original — title, author line, a link to the license, and a note that changes were made. The suggested attribution string is in the license page.
• You must keep the same license. Anything you build on this book is CC BY-SA 4.0 too. You cannot fold it into a closed product, and you cannot add DRM or contractual terms that restrict what the license permits.

There is no adoption form, no sales representative, no institutional agreement, and nothing to notify anyone about. You may simply put the URL in your syllabus this afternoon. If you do build a substantial adaptation, we would like to hear about it — not for permission, which you already have, but so it can be listed for others.

If you change only one thing about how you teach this course

Adopt the Case File project. Not the book — the project. It works with any textbook, and it is the intervention most likely to change your outcomes.

The argument is short. Your exams ask within-system questions, because within-system questions are what a chapter contains and what a test bank supplies. Students therefore study within-system, and the ones who study hard pass. Then in pathophysiology, pharmacology, biomechanics, clinicals, or on the MCAT, every question of consequence is between-system — and your best students discover that the thing they were rewarded for is not the thing that is now required. We all know this. Almost nobody's course structure does anything about it, because integration is treated as an outcome we hope emerges rather than a skill we schedule.

The Case File makes it a scheduled skill. Six sentences per chapter. One patient. One rule: connect the new system to at least two prior systems, and state the direction of causation each time. Twenty-eight repetitions.

What it costs you: roughly twenty minutes a week if you use the spot-check schedule in Rubrics, and one class period at Chapter 33. What it buys is visible around Chapters 16 to 17, when the renin–angiotensin–aldosterone system ties heart, vessels, kidney, and adrenal into one loop and a noticeable fraction of the room stops treating organ systems as separate chapters. Students describe that moment unprompted on course evaluations. It is the closest thing to a reliable effect this book has.

If your program has a comprehensive final, a capstone, or a pathophysiology sequence downstream, the Case File is also the cleanest artifact you have for demonstrating integrative outcomes to an accreditor.

Known limitations, honestly

Where you will need to supplement, in rough order of urgency:

1. Visual anatomy. The book cannot teach three-dimensional relationships or surface anatomy from a page. Gross anatomy of the skeleton, the muscles, the brain, and the vessel trees needs models, plates, prosections, or good slides. Budget lab and lecture time accordingly; see Laboratory Alignment.
2. Histology recognition. The Histology sidebars explain what you would see and why it looks that way, which is the right conceptual preparation — but recognizing pseudostratified ciliated columnar epithelium on an unlabeled slide is a perceptual skill that only slides or virtual-microscopy collections build.
3. Muscle and vessel nomenclature at volume. Chapters 10 and 19 and Appendices D and E give the tables, but drilling several hundred names requires spaced retrieval tooling — flashcards, a practical, a naming quiz — that the book does not supply.
4. Auto-graded homework. No LMS integration ships with this. Item banks are provided in plain Markdown; most learning management systems import from a simple text or QTI conversion, which is a one-time hour of work per course.
5. Pathophysiology depth. Pathology in this book is always in service of normal mechanism. If your course is really an A&P-plus-pathophysiology hybrid — some accelerated allied-health programs are — you will supplement Chapters 17 through 22 substantially.
6. Pharmacology. Drugs appear only where they illuminate a mechanism (beta blockade, loop diuretics, statins, ACE inhibitors). There is no systematic pharmacology.
7. Chapter-to-chapter unevenness. This is an actively developing open text. Some chapters are longer and more polished than others, and the fastest way to fix the one that annoys you is to send a correction; see Contributing and Errata.

Where to go next in this companion

• Pacing Guides — week-by-week schedules for five course formats, plus a difficulty and time index for all 33 chapters.
• Laboratory Alignment — the standard two-semester lab sequence mapped to chapters, with low-cost and no-dissection alternatives and a guide to running a practical.
• Assessment Bank — secure items beyond those in the student text, clinical vignettes, and a section on writing good A&P questions.
• Case File Project Rubrics — the full analytic instrument, a worked example at all four levels, and how to grade it at scale.
• Common Misconceptions and How to Break Them — the most practically useful page here. Read it before you teach the unit, not after the exam.

Next: Pacing Guides — five formats, week by week.