Forced Disruption of Anatomy Education in Australia and New Zealand: An Acute Response to the Covid-19 Pandemic

Australian and New Zealand universities commenced a new academic year in February/March 2020 largely with “business as usual.” The subsequent Covid-19 pandemic imposed unexpected disruptions to anatomical educational practice. Rapid change occurred due to government-imposed physical distancing regulations from March 2020 that increasingly restricted anatomy laboratory teaching practices. Anatomy educators in both these countries were mobilized to adjust their teaching approaches. This study on anatomy education disruption at pandemic onset within Australia and New Zealand adopts a social constructivist lens. The research question was “What are the perceived disruptions and changes made to anatomy education in Australia and New Zealand during the initial period of the Covid-19 pandemic, as reflected on by anatomy educators?.” Thematic analysis to elucidate “the what and why” of anatomy education was applied to these reflections. About 18 anatomy academics from ten institutions participated in this exercise. The analysis revealed loss of integrated “hands-on” experiences, and impacts on workload, traditional roles, students, pedagogy, and anatomists' personal educational philosophies. The key opportunities recognized for anatomy education included: enabling synchronous teaching across remote sites, expanding offerings into the remote learning space, and embracing new pedagogies. In managing anatomy education's transition in response to the pandemic, six critical elements were identified: community care, clear communications, clarified expectations, constructive alignment, community of practice, ability to compromise, and adapt and continuity planning. There is no doubt that anatomy education has stepped into a yet unknown future in the island countries of Australia and New Zealand.     

Anatomy education beyond the Covid-19 pandemic: A changing pedagogy

The coronavirus disease 2019 (Covid-19) pandemic has induced multifaceted changes in anatomical education. There has been a significant increase in the employment of digital technologies coupled with the upskilling of educators' capacity and altered attitudes toward the digitalization process. While challenges remain, learners have demonstrated capabilities to adapt to digital delivery, engagement and assessment. With alternative and innovative teaching and learning strategies having been trialed and implemented for almost two years, the key question now is what the pedagogy will be for anatomy education beyond the pandemic. Here we discuss some of the changes in anatomy education that have taken place as a result of the Covid-19 pandemic and importantly present some outlooks for evidence-based anatomy pedagogy as the world enters the post-pandemic phase and beyond. The authors conclude that the anatomy discipline is ready to further modernize and has the opportunity to use digital technologies to evolve and enhance anatomy education to ensure students are provided with the learning experience which will prepare them best for the future.     

Gross Anatomy Education in China during the Covid-19 Pandemic: A National Survey

The Covid-19 pandemic launched the use of online courses in Chinese medical schools during February 2020. To evaluate the state of gross anatomy education in China during the pandemic, a nationwide survey was conducted through convenience sampling by email or respondent invitations on social media. A total of 359 questionnaires were received from the respondents. The first response from a given school was included in the study to represent that school, thus, 77 questionnaires were used for analyses. Schools represented were from all provinces in mainland China as well as Hong Kong and Macao. The survey found that before the pandemic, 74.0% and 33.8% of the 77 schools conducted online theoretical and practical sessions, respectively, on gross anatomy, and 36 (46.8% of 77) had temporarily suspended practical sessions at the time the survey was conducted. Body donation programs were also affected with 26.0% and 27.3% of the 77 schools having suspended donation programs or saw a decreased number of donations. During the pandemic, 40.3% of the 77 schools kept or initiated the implementation of active learning, and online assessment was continued in 49.4% of the 77 medical schools. Another 26 (33.8%) schools initiated online assessment during the pandemic. A total of 359 answers were included for the analysis of the “teachers’ perception of the online teaching experience.” Over half (51.0%) of the 359 responded teachers were very statisfied or satisfied with the effectiveness of online teaching during the pandemic. A total of 36.2% of these respondents preferred to implement online teaching of theoretical sessions after the pandemic, and 89 (24.8%) teachers were keen to return to traditional face-to-face anatomy education.     

One year of anatomy teaching and learning in the outbreak: Has the Covid-19 pandemic marked the end of a century-old practice? A systematic review

At the end of 2019, the Covid-19 pandemic spread caused restrictions in business and social spheres. Higher education was also severely affected: universities and medical schools moved online to distance learning and laboratory facilities closed. Questions arise about the long-term effects of this pandemic on anatomical education. In this systematic review, the authors investigated whether or not anatomical educators were able to deliver anatomical knowledge during this pandemic. They also discuss the challenges that anatomical education has faced over the last year. The search strategy was conducted between July 2020 and July 2021. Two hundred and one records were identified, and a total of 79 studies were finally included. How best to deliver anatomy to students remains a moot point. In the last years, the advent of new technologies has raised the question of the possible overcoming of dissection as the main instrument in anatomical education. The Covid-19 pandemic further sharpened the debate. Remote learning enhanced the use of technologies other than cadaveric dissection to teach anatomy. Moreover, from the analyzed records it appears that both from students' perspective as well as teachers' there is a clear tear between those who endorse dissection and those who believe it could be easily overcome or at least integrated by virtual reality and online learning. The authors strongly believe that the best anatomy teaching practice requires the careful adaptation of resources and methods. Nevertheless, they support cadaveric dissection and hope that it will not be replaced entirely as a result of this pandemic.     

How student perceptions about online learning difficulty influenced their satisfaction during Canada's Covid-19 response

The COVID-19 pandemic has posed a significant challenge to higher education and forced academic institutions across the globe to abruptly shift to remote teaching. Because of the emergent transition, higher education institutions continuously face difficulties in creating satisfactory online learning experiences that adhere to the new norms. This study investigates the transition to online learning during Covid-19 to identify factors that influenced students' satisfaction with the online learning environment. Adopting a mixed-method design, we find that students' experience with online learning can be negatively affected by information overload, and perceived technical skill requirements, and describe qualitative evidence that suggest a lack of social interactions, class format, and ambiguous communication also affected perceived learning. This study suggests that to digitalize higher education successfully, institutions need to redesign students' learning experience systematically and re-evaluate traditional pedagogical approaches in the online context.

Practitioner notes

What is already known about this topic

• University transitions to online learning during the Covid-19 pandemic were undertaken by faculty and students who had little online learning experience.
• The transition to online learning was often described as having a negative influence on students' learning experience and mental health.
• Varieties of cognitive load are known predictors of effective online learning experiences and satisfaction.

What this paper adds

• Information overload and perceptions of technical abilities are demonstrated to predict students' difficulty and satisfaction with online learning.
• Students express negative attitudes towards factors that influence information overload, technical factors, and asynchronous course formats.
• Communication quantity was not found to be a significant factor in predicting either perceived difficulty or negative attitudes.

Implications for practice and/or policy

• We identify ways that educators in higher education can improve their online offerings and implementations during future disruptions.
• We offer insights into student experience concerning online learning environments during an abrupt transition.
• We identify design factors that contribute to effective online delivery, educators in higher education can improve students' learning experiences during difficult periods and abrupt transitions to online learning.

     

Factors impacting the rapid transition of anatomy curricula to an online environment in response to Covid-19

Due to the Covid-19 pandemic, many academic institutions had to rapidly transition education to a remote online environment. While a hurdle for most educators, this transition posed an even greater challenge for anatomy educators, many of whom were forced to depart from the traditional cadaver-based laboratory to a virtual format. Recent publications have discussed the rapid transition to online formats necessitated by Covid-19 and the accompanying difficulties, but none have identified specific factors that influenced the difficulty of this transition. Anatomy educators were surveyed to examine how this transition was accomplished and perceived. Of the 165 educators who responded, the majority utilized cadaver-based laboratory instruction. Educators felt that transitioning the laboratory portion of their courses was significantly more difficult and required more time than converting lecture materials. Factors that impacted the difficulty of the transition included a number of pedagogical aspects of the pre-Covid-19 curricula, including the delivery format of prior content, availability of pre-existing electronic materials, and the laboratory technique previously used. Additionally, the length of time an educator had been teaching prior to Covid-19 impacted their perception of difficulty, with newer and more senior educators finding this much more challenging than mid-tenure educators. Ease of transition may be related to previous exposure to curricular reform, experience with multiple anatomy pedagogies, and educator adaptability. While not surprising that converting a cadaver-based laboratory to an online format was challenging, knowledge of the alignment of this difficulty with prior educator pedagogy can help guide future innovations to anatomy education.     

Evolving strategies in whirlwind mode: The changing face of anatomy education during Covid-19 pandemic

The Covid-19 pandemic stipulated adoption of unfamiliar strategies for delivering anatomy education in online mode. The factors which determine education strategies are variable across geographical regions. It was perceived that an overview of education strategies around the globe would be useful for anatomists. Hence this narrative review was undertaken to collate observations from different geographical regions pertaining to education strategies adopted during the pandemic. Data relevant to the topic of study were extracted from 12 articles that were selected from an initial pool of 317 articles based on search criteria set for the review. Subtle differences in core education strategies implied that baseline response from anatomists was similar across regions. It was evident that online digital tools were key elements of education strategies adopted by educators for delivering online anatomy classes across the globe. Interestingly, a considerable gap in terms of number and variety of online tools used for anatomy education (those requiring commercial purchase) was noted between economically developed and developing regions. This may have an impact on learning outcome for students and may even lead to variations in anatomical knowledge by regions. It was observed that offline human dissection sessions were incorporated into online practical classes in one region as positive cases showed a declining trend. This positive development is worth emulating elsewhere based on cautious assessment of prevailing situation. From a broad perspective timely introduction of education strategies ensured delivery of anatomy education during the pandemic and gave an evolved outlook to the fabric of anatomy education.     

Is remote near-peer anatomy teaching an effective teaching strategy? Lessons learned from the transition to online learning during the Covid-19 pandemic

In response to the Covid-19 pandemic, medical educators have transformed pre-clerkship anatomy curricula into online formats. The purpose of this study was to evaluate the effectiveness and student perceptions of an online near-peer anatomy curriculum. The classes of 2022 and 2023 completed identical foundational anatomy curricula in-person, whereas the class of 2024 completed an adapted curriculum for remote online learning. Quantitative and qualitative responses were used to compare attitudes between instructional methods. Assessment scores and evaluation survey responses were collected from the classes of 2022 (n = 185), 2023 (n = 184), and 2024 (n = 183). Mean assessment scores (±SD) for the classes of 2022, 2023, and 2024 were 93.64% (±5.86), 93.75% (±4.09), and 92.04% (±4.83), respectively. Post hoc group comparisons showed the class of 2024 scored significantly lower than the two previous classes [2022: (H(1) = 18.58, P < 0.001), 2023: (H(1) = 18.65, P < 0.001)]. Mean survey results concerning curriculum quality were 4.06/5.00 for the class of 2023 and 3.57/5.0 for the class of 2024 (t(365) = 2.67, P = 0.008). Considering a small effect size (η² = 0.034), there was no meaningful difference in student assessment scores. A potential drawback of online near-peer anatomy teaching remains in student perceptions of course quality; qualitative feedback suggested technological limitations and perceptions of online course instructors were partly responsible for lower student satisfaction. Following the Covid-19 pandemic, medical educators should incorporate the lessons learned from this unique educational inflection point to improve curricula moving forward.     

Dyad pedagogy in practical anatomy: A description of the implementation and student perceptions of an adaptive approach to cadaveric teaching

Prior to the challenges imposed by the Covid-19 pandemic, anatomy practical sessions at Trinity College Dublin involved eight to 10 students per donor station, rotating between digital learning, anatomical models/osteology, and dissection activities for three hours weekly. To maintain cadaveric participation in the anatomy laboratory while adhering to distancing guidelines, a transition to dyad pedagogy was implemented. This mode of delivery allowed two students per donor station to spend one hour per week in the anatomy laboratory with all digital learning elements transferred to the virtual learning platform Blackboard as pre- and post-practical session learning activities. Dyad pedagogy has been explored in clinical settings and simulation procedural-based training but is yet to be fully verified in anatomy education. To determine the effectiveness of hybrid practical sessions and reduced donor to student ratios, the opinions of first year medical students were examined using an online questionnaire with a 51% response rate. Although students recognized the merits of more time in the anatomy laboratory, including opportunities for self-directed study and exposure to anatomical variation, they felt that having two students per station enabled sufficient hands-on time with the donor body and fostered learning opportunities that would not be possible with larger groups. Strong preferences for quality time with the donor body supported by online resources suggests this modality should be a key consideration in course design for anatomy curricula and emphasizes the importance of gauging students' preferences to optimize satisfaction and learning output when pivoting to blended learning strategies in anatomy education.     

Ethical Responses to the Covid-19 Pandemic: Implications for the Ethos and Practice of Anatomy as a Health Science Discipline

The move of much anatomy teaching online in response to the Covid-19 pandemic has been successfully implemented within very short time frames. This has necessitated a high degree of dependence upon the use of digitized cadaveric resources, has entailed immense workload demands on staff, and has disrupted students' studies. These educational exigencies have been accompanied by ethical uncertainties for a discipline centered on study of the dead human body. An ethical framework for anatomy is suggested based on the principles of equal concern and respect, minimization of harm, fairness, and reciprocity, in which all staff and students are to be treated with respect and as moral equals. A series of ethical obligations are proposed as a means of maintaining the ethos of anatomy, coping with the suspension of body donation, providing adequate resources, and responding to increased dependence upon external providers. Good academic practice raises more general obligations stemming from the welfare of students, the increased workload of staff, and checking on online assessment and invigilation. As anatomists respond to the educational and ethical lessons prompted by this pandemic, they should plan for future disruptions to normal work patterns by adopting a sustainable and equitable course of action.     

Strength,Weakness, Opportunity,Threat (SWOT) Analysis of the Adaptations to Anatomical Education in the United Kingdom and Republic of Ireland in Response to the Covid-19 Pandemic

The Covid-19 pandemic has driven the fastest changes to higher education across the globe, necessitated by social distancing measures preventing face-to-face teaching. This has led to an almost immediate switch to distance learning by higher education institutions. Anatomy faces some unique challenges. Intrinsically, anatomy is a three-dimensional subject that requires a sound understanding of the relationships between structures, often achieved by the study of human cadaveric material, models, and virtual resources. This study sought to identify the approaches taken in the United Kingdom and Republic of Ireland to deliver anatomical education through online means. Data were collected from 14 different universities in the United Kingdom and Republic of Ireland and compared adopting a thematic analysis approach. Once themes were generated, they were collectively brought together using a strength, weakness, opportunity, threat (SWOT) analysis. Key themes included the opportunity to develop new online resources and the chance to engage in new academic collaborations. Academics frequently mentioned the challenge that time constrains could place on the quality and effectiveness of these resources; especially as in many cases the aim of these resources was to compensate for a lack of exposure to cadaveric exposure. Comparisons of the actions taken by multiple higher education institutions reveal the ways that academics have tried to balance this demand. Discussions will facilitate decisions being made by higher education institutions regarding adapting the curriculum and assessment methods in anatomy.     

Anatomy 3.0: Rediscovering Theatrum Anatomicum in the wake of Covid-19

The Covid-19 pandemic has challenged medical educators internationally to confront the challenges of adapting their present educational activities to a rapidly evolving digital world. In this article, the authors use anatomy education as proxy to reflect on and remap the past, present, and future of medical education in the face of these disruptions. Inspired by the historical Theatrum Anatomicum (Anatomy 1.0), the authors argue replacing current anatomy dissection laboratory (Anatomy 2.0) with a prototype anatomy studio (Anatomy 3.0). In this studio, anatomists are web-performers who not only collaborate with other foundational science educators to devise meaningful and interactive content but who also partner with actors, directors, web-designers, computer engineers, information technologists, and visual artists to master online interactions and processes in order to optimize students' engagement and learning. This anatomy studio also offers students opportunities to create their own online content and thus reposition themselves digitally, a step into developing a new competency of stage presence within medical education. So restructured, Anatomy 3.0 will prepare students with the skills to navigate an emergent era of tele and digital medicine as well as help to foreshadow forthcoming changes in medical education.     

Student Perception and the Effectiveness of Kahoot!: A Scoping Review in Histology,Anatomy, and Medical Education

The impact of the Covid-19 pandemic has presented challenges in medical education particularly, with development of online learning in a short time period. Notably there has been a significant increase in the use of digital technology applications to meet this challenge. For instance, in the first quarter of 2020 the game-based software Kahoot! reported a threefold increase in players and a fivefold increase in asynchronous learning globally. However, there is limited research into the use of game-based digital technology applications such as Kahoot! and the associated learning theories, particularly in histology, anatomy, and medical education. This scoping review explored the utilization, outcome scores, and student perceptions of learning with the application of Kahoot! in histology, anatomy, and medical education. Online databases were used to identify articles published between 2013 and 2021 from which 12 articles were included in the review. The majority of articles supported positive student outcomes including improved collaborative learning, improved knowledge of content, attendance, and participation. Minor negative aspects included increased time on task, overwhelming learning content, and distractions due to gadgets. None of the articles included a control group. The main educational theories identified were active learning followed by social and constructivism learning theory. In light of the Covid-19 pandemic a rapid and fundamental shift in how digital applications are being used in educational institutions has evolved. Further research on learning frameworks and studies with control groups is required to evaluate Kahoot! as a potentially valuable online application in histology, anatomy, and medical education.     

An Analysis of Anatomy Education Before and During Covid-19: May–August 2020

Coronavirus disease 2019 (Covid-19) created unparalleled challenges to anatomy education. Gross anatomy education has been particularly impacted given the traditional in-person format of didactic instruction and/or laboratory component(s). To assess the changes in gross anatomy lecture and laboratory instruction, assessment, and teaching resources utilized as a result of Covid-19, a survey was distributed to gross anatomy educators through professional associations and listservs. Of the 67 survey responses received for the May–August 2020 academic period, 84% were from United States (US) institutions, while 16% were internationally based. Respondents indicated that in-person lecture decreased during Covid-19 (before: 76%, during: 8%, P < 0.001) and use of cadaver materials declined (before: 76 ± 33%, during: 34 ± 43%, P < 0.001). The use of cadaver materials in laboratories decreased during Covid-19 across academic programs, stand-alone and integrated anatomy courses, and private and public institutions (P ≤ 0.004). Before Covid-19, cadaveric materials used in laboratories were greater among professional health programs relative to medical and undergraduate programs (P ≤ 0.03) and among stand-alone relative to integrated anatomy courses (P ≤ 0.03). Furthermore, computer-based assessment increased (P < 0.001) and assessment materials changed from cadaveric material to images (P < 0.03) during Covid-19, even though assessment structure was not different (P > 0.05). The use of digital teaching resources increased during Covid-19 (P < 0.001), with reports of increased use of in-house created content, BlueLink, and Complete Anatomy software (P < 0.05). While primarily representing US institutions, this study provided evidence of how anatomy educators adapted their courses, largely through virtual mediums, and modified laboratory protocols during the initial emergence of the Covid-19 pandemic.     

An Adaptive Blended Learning Model for the Implementation of an Integrated Medical Neuroscience Course During the Covid-19 Pandemic

The implementation of an integrated medical neuroscience course by technologically pivoting an in-person neuroscience course to online using an adaptive blended method may provide a unique approach for teaching a medical neuroscience course during the Covid-19 pandemic. An adaptive blended learning method was developed in response to the requirements necessitated by the Covid-19 pandemic. This model combined pedagogical needs with digital technology using online learning activities to implement student learning in a medical neuroscience course for year one medical students. This approach provided medical students with an individually customized learning opportunity in medical neuroscience. The students had the complete choice to engage the learning system synchronously or asynchronously and learn neuroscience materials at different locations and times in response to the demands required to deal with the pandemic. Students' performance in summative and formative examinations of the adaptive blended learning activities were compared with the previous performance obtained the previous year when the contents of the medical neuroscience course were implemented using the conventional “face-to-face” learning approach. While the cohort of our students in 2019 and 2020 changed, the contents, sessions, volume of material, and assessment were constant. This enabled us to compare the results of the 2019 and 2020 classes. Overall, students' performance was not significantly different between the adaptive blended learning and the in-person approach. More students scored between 70% and 79% during the adaptive blended learning compared with in-class teaching, while more students scored between 80% and 89% during the in-person learning than during the adaptive blended learning. Finally, the percentage of students that scored >90% was not significantly different for both Years 2019 and 2020. The adaptive blended learning approach was effective in enhancing academic performance for high-performing medical students. It also permitted the early identification of underachieving students, thereby serving as an early warning sign to permit timely intervention.     

The impact of asynchronous online anatomy teaching and smaller learning groups in the anatomy laboratory on medical students’ performance during the Covid-19 pandemic

Due to the Covid-19 pandemic, National Taiwan University anatomy teachers adopted asynchronous online video teaching and reduced the size of anatomy laboratory groups in April 2020. The aim of this study was to investigate the impact of these changes on medical students’ learning. Before Covid-19, the performance of the 2019–2020 cohort was significantly better than that of the 2018–2019 cohort. However, the implementation of modified teaching strategies significantly lowered the laboratory midterm score of the 2019–2020 cohort in the second semester. Conversely, the final laboratory examination score of the 2019–2020 cohort was significantly higher than that of the 2018–2019 cohort. Through correlation analysis, lecture and laboratory examination scores were highly correlated. Additionally, the difference in lecture and laboratory z-scores between two cohorts, the Likert scale survey and free-text feedback of the 2019–2020 cohort, were conducted to show the impact of modified teaching strategies. There were several important findings in this study. First, the change in teaching strategies may temporarily negatively influence medical students to learn anatomy. Besides, analyzing the performance of laboratory assessments could be a complementary strategy to evaluate online assessments. Applying lecture examination scores to predict laboratory performance was a feasible way to identify students who may have difficulty in learning practical dissection. Finally, reducing group size together with reduced peer discussion may have a negative effect on learning cadaver dissection for students with low academic performance. These findings should be taken into consideration when anatomy teachers apply new teaching strategies in anatomy courses.     

Notes on a Crisis: The Pandemic and English Schools

ABSTRACT

The Covid-19 pandemic has created global disruption in education. It has served to highlight pre-existing inequalities, at the same time as it has stimulated new forms of educational provision, notably ‘online learning’. This article focuses on the debates and conflicts provoked by the pandemic’s impact on schooling in England. It aims to show how the historic policy preferences of Conservative governments have been carried forwards into a new situation and suggests how such preferences are at odds with ways of working developed by teachers. It places these different orientations in a broader European context and identifies a common tendency to evoke a meaning of teaching represented as at odds with the policy choices that have characterised government response to the pandemic.     

Remote learning during Covid-19 lockdown: A study on anatomy and histology education for pharmacy students in Jordan

The Covid-19 pandemic has changed almost all aspects of education. The anatomy and histology courses for pharmacy students focus heavily on the face-to-face communication of theory and practical knowledge, and due to the pandemic, only theory content was delivered in an online format. This brought up many concerns about pharmacy student preparedness. This work explores the effectiveness and student perspective of remote teaching of the theoretical anatomy and histology course in Jordanian universities from the perspective of pharmacy students. The objectives are to determine the strengths, challenges, and the effectiveness of remote delivery on student learning. An online-based validated questionnaire was distributed to students majoring in Pharmacy and enrolled in the course during the second semester of 2019–2020 at 11 universities in Jordan. A total of 442 students participated in the study. Results showed that there were significant differences in perceptions of the social media platforms used in distance learning and remote delivery of the course. Most participants had positive perceptions of the educational process and studying via distance learning. There were many strengths noted including time flexibility and several challenges such as the lack of face-to-face interaction with instructors, inadequate internet connectivity, and technical issues. In conclusion, online-taught anatomy and histology course during the Covid-19 lockdown in Jordan was a success as perceived by students, but the course still possessed challenges need to be overcome in the future.     

医学院校低年级医学生网络教学研究

新冠疫情期间,全国高校积极开展网上教学,医学院校也不例外。在此过程中,发现了一些问题,也积累了一些经验。主要总结低年级医学生网络授课期间学生反馈的问题以及学习体验,旨在不断提升在线教学效果,改善学习质量,帮助学生在网上授课的情况下也能够接受优质、高效的医学教育。