Movement System Theory and Anatomical Competence: Threshold Concepts for Physical Therapist Anatomy Education

This viewpoint proposes eight anatomy threshold concepts related to physical therapist education, considering both movement system theory and anatomical competence. Movement system theory provides classifications and terminology that succinctly identifies and describes physical therapy practice from a theoretical and philosophical framework. The cardiovascular, pulmonary, endocrine, integumentary, nervous, and musculoskeletal systems are all included within this schema as the movement system theory encompasses all body systems interacting to create movement across the lifespan. Implementing movement system theory requires an ability to use human anatomy in physical therapist education and practice. Understanding the human body is a mandatory prerequisite for effective diagnosis, assessment, treatment, and patient evaluation. Anatomical competence refers to the ability to apply anatomic knowledge within the appropriate professional and clinical contexts. Exploring the required anatomical concepts for competent entry-level physical therapist education and clinical practice is warranted. The recommended threshold concepts (fluency, dimensionality, adaptability, connectivity, complexity, stability or homeostasis, progression or development, and humanity) could serve as an integral and long-awaited tool for guiding anatomy educators in physical therapy education.     

The wider importance of cadavers: Educational and research diversity from a body bequest program

The debate surrounding the use of cadavers in teaching anatomy has focused almost exclusively on the pedagogic role of cadaver dissection in medical education. The aim of this study was to explore the wider aspects of a body bequest program for teaching and research into gross anatomy in a University setting. A retrospective audit was undertaken on body donation and the use of cadaver specimens for teaching and research at our institution between 1876 and 2009. The body bequest program, first established in 1943, now receives more than 40 donations per year. In addition to the medical course, nine other University degrees and courses currently use cadaver specimens for gross anatomy; four of these are research degrees and the remainder undergraduate degrees and courses. The use of cadaver specimens by non‐University groups has also increased, particularly during the past decade, such that there are now 16 different groups using cadaver specimens for instructional courses; most of these are professional medical courses. The use of cadavers for both research and teaching may encourage a more evidence‐based approach to clinical anatomy. This unique audit, spanning more than a century of anatomy education within a single University Medical School, highlights the utility of a robust body bequest program and the wide range of students and health professionals who interact with this precious resource. Anat Sci Educ 2:234–237, 2009 © 2009 American Association of Anatomists.     

Attitudes of Australian chiropractic students toward whole body donation: A cross‐sectional study

Cadavers play an important role in anatomy education. In Australia, bodies for anatomy education are acquired only through donations. To gain insight into educational dynamics in an anatomy laboratory as well as to facilitate body donation programs and thanksgiving ceremonies, it is important to understand students' attitudes toward body donation. In this cross‐sectional study, the attitudes of Macquarie University's first, second, and fifth year chiropractic students toward body donation were investigated. Macquarie University chiropractic students have a four semester long anatomy program, which includes cadaver‐based instruction on prosected specimens. A questionnaire was used to record respondents' demographics and attitudes toward body donation: personal, by a relative, and by a stranger. It was found that ethnicity and religion affect attitudes toward body donation, with Australian students being more willing to donate a stranger's body and atheists and agnostics being more willing to donate in general. Furthermore, willingness to donate one's own or a family member's body decreases as year of study increases, suggesting a possible negative impact of exposure to cadavers in the anatomy laboratory. This was only true, however, after controlling for age. Thus, the impact of viewing and handling prosected specimens, which is the norm in anatomy classes in Australia, may not be as strong as dissecting cadavers. It is suggested that anatomists and educators prepare students for cadaver‐based instruction as well as exhibit sensitivity to cultural differences in how students approach working with cadavers, when informing different communities about body donation programs and in devising thanksgiving ceremonies. Anat Sci Educ 7: 117–123. © 2013 American Association of Anatomists.     

Use of individual feedback during human gross anatomy course for enhancing professional behaviors in doctor of physical therapy students

Medical professionals and public consumers expect that new physical therapy graduates possess cognitive, technical, and behavioral skills required to provide safe and high‐quality care to patients. The purpose of this study was to determine if a repertoire of ten professional behaviors assessed at the beginning of doctorate of physical therapy education and before the first significant clinical internship could be enhanced in a semester course in gross human anatomy using individual formative feedback. During the human anatomy course, 28 first‐year physical therapy students completed six biweekly, anonymous self‐ and peer assessment surveys that targeted ten professional behaviors important to physical therapists. All professional behaviors were assessed using a five‐point Likert scale. Feedback reports occurred at week eight (mid‐semester) and week 16 (end‐of‐semester) and comprised the direct intervention components of this study. At the midpoint of the semester, professional behavior scores and narrative comments from weeks two, four, and six were compiled and shared with each student by one of three faculty members in a feedback session. Students then submitted biweekly self‐and peer professional behavior assessments (weeks 10, 12, and 14) for the remainder of the human anatomy course. Differences between preintervention and postintervention scores for each of the ten professional behaviors were compared using the Wilcoxon signed‐ranks test. Upon receiving mid‐semester individual feedback, students demonstrated significant improvement in each of the ten professional behaviors. Results from this study indicated a gross anatomy laboratory dissection experience during the first academic semester provided an effective opportunity for teaching and assessing professional behaviors of doctoral students in physical therapy. Anat Sci Educ 6: 324–331. © 2013 American Association of Anatomists.     

Not Just a Specimen: A Qualitative Study of Emotion,Morality, and Professionalism in One Medical School Gross Anatomy Laboratory

Medical schools are increasingly integrating professionalism training into their gross anatomy courses, teaching ethical behavior and humanistic attitudes through the dissection experience. However, many schools continue to take a traditional, technical approach to anatomical education while teaching professionalism in separate courses. This interview-based study explored how students viewed the body donor and the professional lessons they learned through dissection at one such medical school. All students oscillated involuntarily between seeing the cadaver as a specimen for learning and seeing the cadaver as a person, with some students intentionally cultivating one of these ways of seeing over the other. These views shaped students’ emotional and moral responses to the experiences of dissection. The “specimen” view facilitated a technical, detached approach to dissection, while the “person” view made students engage emotionally. Further, students who intentionally cultivated a “specimen” view generally felt less moral distress about dissection than students who intentionally cultivated a “person” view. The concept of respect gave students permission to perform dissections, but “person-minded” students developed more complex rules around what constituted respectful behavior. Both groups of students connected the gross anatomy experience to their professional development, but in different ways. “Specimen-minded” students intentionally objectified the body to learn the emotional control physicians need, while “person-minded” students humanized the body donor to promote the emotional engagement required of physicians. These findings support efforts to integrate professionalism teaching into gross anatomy courses, particularly content, addressing the balance between professional detachment and concern.     

Humanities in Gross Anatomy Project: A novel humanistic learning tool at Des Moines University

Gross anatomy affords physical therapy students an opportunity to discover human morphology by intimately studying the dead. Moreover, it also exposes future physical therapists to the humanistic aspects of the profession. In 2007, anatomy faculty decided to socialize students to the humanities with a new course requirement: Humanities in Gross Anatomy Project (HuGA) Project. At the end of the course, students, either individually or as a group, submitted a project that described how they had been personally touched by the donor's gift and how the gift contributed to their professional growth and education. The submission could be in the form of a narrative, poem, song, video, etc. All students met the three grading criteria that were established; thus taking the first step in socializing themselves to the humanistic domain of their professional education. In summary, the HuGA project is a novel educational tool that formally provided physical therapy students with humanistic learning opportunities in a gross anatomy course and appeared to facilitate reflective learning. The utilization of reflection as it relates to clinical decision making and patient interaction is critical for physical therapy practice. Anat Sci Educ 3: 94–96, 2010. © 2010 American Association of Anatomists.     

An overview of the roles and responsibilities of Chinese medical colleges in body donation programs

The use of human tissue is critical for gross anatomy education in the health professions. Chinese medical colleges have faced a shortage of anatomical specimens over the past decade. While body donation plays an important role in overcoming this gap, this practice has only recently been introduced in China, and the donation rate is relatively low and fraught with a number of difficulties. In the past, traditional Chinese culture focused on preserving the human body intact, which often limited body donation. In recent years, the public has become more open toward body donation. At Nanjing Medical University, only 20 bodies were donated in 2001. After the university became involved in an organized body donation program, this number increased to 70 donated bodies per year (2007 to 2012). This article describes and reviews Chinese medical colleges as a special case study among body donation programs, particularly in terms of the multiple responsibilities and roles that such institutions must assume in the course of adopting these programs. Medical colleges in China must serve as advocates, coordinators, builders, managers, educators, and beneficiaries in undertaking body donation programs. It is important for medical colleges to recognize these pluripotent roles and educate the public in order to promote body donation programs. This case study may also effectively guide and encourage Chinese medical colleges in refining their own body donation programs in the future. Anat Sci Educ 7: 312–320. © 2013 American Association of Anatomists.     

Curriculum of gross anatomy education in Korean dental hygiene programs: Perceptions of clinical dental hygienists

It is essential for dental hygienists to have basic knowledge of gross anatomy to provide efficient treatment. However, gross anatomy course is relatively neglected due to their disparity from actual clinical dental practice. This study aimed to propose an effective dental hygiene gross anatomy curriculum that reflects the opinions of professional clinical dental hygienists. The study had an online-based cross-sectional design and the survey was distributed to clinical dental hygienists via social networks (n = 200). The questionnaire consisted of questions on the utilization of anatomical knowledge in clinical practice, opinions on the contents and methods of gross anatomy education, and general characteristics. The present study found that 186 (93%) used anatomical knowledge at an above-average level. Qualitative analysis indicated that dental implant surgery, radiography, and extraction were the clinical procedures that required the most anatomical knowledge. The clinical dental hygienists answered that the most-necessary knowledge is that of the mandibular nerve, followed by that on the temporomandibular joint, mandible, maxilla, maxillary nerve, and masticatory muscle. The methods proposed to improve gross anatomy education were (in decreasing order of importance) using videos or photographs (X-rays, CT, MRI, etc.), integrating education with clinical subjects, and using a three-dimensional visualization program. Higher education levels of respondents have increased their tendency to believe that the contents and methods of the presented education were necessary. Dental hygienists who utilized anatomical knowledge more often tended to be had a greater appreciation of the necessity of all educational contents and methods.     

Altruism in death: Attitudes to body and organ donation in Australian students

Health education, research, and training rely on the altruistic act of body donation for the supply of cadavers. Organ transplantation and research rely on donated organs. Supply of both is limited, with further restrictions in Australia due to requirements for a next-of-kin agreement to donation, irrespective of the deceased's pre-death consent. Research suggests health workers are less likely to support the donation of their own bodies and/or organs, despite recognizing the public good of donation, and that exposure to gross anatomy teaching may negatively affect support for donation. Attitudes to body and organ donation were examined in Australian students studying anatomy. Support for self-body donation (26.5%) was much lower than support for self-organ donation (82.5%). Ten percent of participants would not support the election of a family member or member of the public to donate their body, and just over 4% would not support the election of a family member to donate their organs, with one-to-two percent not supporting this election by a member of the public. Exposure to gross anatomy teaching was associated with an increased likelihood of consideration of issues about body and organ donation, whether for self, family, or the public, and registration as an organ donor. Exposure decreased participants' willingness to donate their own body, with those who practiced a religion least likely to support body donation. Gross anatomy courses provide an opportunity to inform future healthcare workers about altruistic donation, albeit with a recognition that religious or cultural beliefs may affect willingness to donate.     

Professional and Personal Competency Development in Near-peer Tutors of Gross Anatomy: A Longitudinal Mixed-methods Study

There are many benefits to peer and near-peer tutoring. The current literature suggests that near-peer teaching within the domain of gross anatomy may lead to the development of numerous competencies for burgeoning medical professionals. The aim of this study was a quantitative and qualitative approach to explore which professional and personal competencies anatomy tutors developed as a result of their teaching activities in a gross anatomy course at a medical school in Germany. For a period of 18 months, 24 peer tutors were followed and queried multiple times via questionnaire and semi-structured interviews. It was found that most of the skills tutors developed or strengthened over one semester matched most of the core competencies described in various official competency frameworks used for physician education. In particular, tutors thought that tutoring gross anatomy had improved their knowledge of professional behavior as well as their communication skills. They also felt that they had learned to take on more responsibility and to use available resources more effectively. Overall, tutoring gross anatomy was perceived as very challenging, but also very rewarding, mainly because it provided the opportunity to develop and strengthen important skills such as self-confidence, self-awareness, positive thinking, self-insight, and stress management. Ultimately, these are all factors that contribute to resilience, an important attribute for physicians.     

Anatomy as a Model Environment for Acquiring Professional Competencies in Medicine: Experiences at Harvard Medical School

Anatomy education provides students with opportunities to learn structure and function of the human body, to acquire professional competencies such as teamwork, interpersonal skills, self-awareness, and to reflect on and practice medical ethics. The fulfillment of this wide potential can present challenges in courses that are part of an integrated curriculum and shorter than traditional courses. This new reality, together with students' increasing concern about the stresses within medical education, led to efforts at Harvard Medical School to implement practical steps toward an optimal learning environment in anatomy. These were based on core elements of ethical anatomy education and principles of trauma-informed care. Anatomy is conceptualized here as the “first clinical discipline,” with relational interactions between anatomical educators, medical students, and body donors/patients. Essential prerequisites for the implementation of this work were support by the medical school leadership, open partnership between engaged students and faculty, faculty coordination, and peer-teaching. Specific interventions included pre-course faculty development on course philosophy and invitations to students to share their thoughts on anatomy. Student responses were integrated in course introductions, combined with a pre-dissection laboratory visit, an introductory guide, and a module on the history and ethics of anatomy. During the course, team-building activities were scheduled, and self-reflection encouraged, for example, through written exercises, and elective life-body drawing. Students' responses to the interventions were overall positive, but need further evaluation. This first attempt of a systematic implementation of an optimal learning environment in anatomy led to the identification of areas in need of adjustment.     

Perceived Benefits of Anatomy Coursework Prior to Medical and Dental School

Student struggles in gross anatomy coursework at the professional level can result in hours of remediation along with a need to allot time and other resources by both the student and the faculty. Since this course typically occurs in the first semester of the first year, programs can turn to admissions data to try to determine which of these students may struggle. This study looked at two years of medical (n = 280) and dental (n = 78) students to determine if there is a relationship between pre-admissions anatomy coursework and performance in gross anatomy at the professional school level. Students provided data regarding their past anatomy coursework and final grades in professional school gross anatomy courses were obtained. In addition, students responded to questions regarding their feelings of preparation and how they valued the prior anatomy coursework as it related to the professional course. Statistical analysis showed no difference in final course grade between students with and without prior anatomy in either program. Counter to the numerical data, 96.6% of the students in the study recommended an anatomy course prior to pursuing a health science degree. The primary reasons given for this recommendation were the benefits of repeated content exposure, knowledge of the anatomy terminology, and decreased stress regarding the course. The results from this study suggest that the benefits of prior anatomy may be seen more in the students’ stress and quality of life rather in the numerical performance of course grades.     

Peer teaching among physical therapy students during human gross anatomy: Perceptions of peer teachers and students

Despite nearly 200 accredited entry‐level physical therapist education programs in the United States that culminate in a doctoral degree, only a paucity of reports have been published regarding the efficacy of peer teaching in gross anatomy. No one has described the usefulness of peer teaching from the viewpoint of the peer teacher. An organized peer teaching method provided by four second‐year doctors of physical therapy (DPT) students in a semester course in gross anatomy had a positive impact on the academic performance in gross anatomy of first‐year DPT students. The unique feature of the weekly peer teaching sessions was a packet assembled by the second‐year peer teachers, which contained diagrams, fill‐in‐the blank questions, and helpful mnemonic devices. This study surveyed perceptions of first‐year DPT students in response to a peer teaching method, using a structured 10‐item questionnaire and a five‐point Likert scale. Second‐year DPT peer teachers provided written reflections about the benefits and challenges of serving as a peer teacher. Results revealed that 13 planned peer‐teaching experiences provided by four second‐year DPT students were valuable and promoted a firm understanding of anatomical relationships important for the clinical competence of physical therapist students. Moreover, peer teachers acknowledged acquiring clinically desirable teaching, academic, organizational, and time management skills from the experience. As a result, physical therapist educators may wish to consider this model of peer teaching to augment their teaching strategies for a class in gross human anatomy. Anat Sci Ed 1:199–206, 2008. © 2008 American Association of Anatomists.     

Team-Based Ultrasound Objective Structured Practice Examination (OSPE) in the Anatomy Course

The clinical use of ultrasound has dramatically increased, necessitating early ultrasound education and the development of new tools in ultrasound training and assessment. The goal of this study was to devise a novel low-resource examination that tested the anatomical knowledge and technical skill of early undergraduate medical students in a gross anatomy course. The team-based ultrasound objective structured practice examination (OSPE) was created as a method for assessing practical ultrasound competencies, anatomical knowledge, and non-technical skills such as teamwork and professionalism. The examination utilized a rotation of students through four team roles as they scanned different areas of the body. This station-based examination required four models and four instructors, and tested ultrasound skills in the heart, abdominal vessels, abdominal organs, and neck regions. A Likert scale survey assessed student attitudes toward the examination. Survey data from participants (n = 46) were examined along with OSPE examination grades (n = 52). Mean and standard deviations were calculated for examination items and survey responses. Student grades were high in both technical (96.5%). and professional (96.5%) competencies with structure identification scoring the lowest (93.8%). There were no statistical differences between performances in each of the body regions being scanned. The survey showed that students deemed the examination to be fair and effective. In addition, students agreed that the examination motivated them to practice ultrasound. The team-based OSPE was found to be an efficient and student-favored method for evaluating integrated ultrasound competencies, anatomical knowledge, team-work, and professional attributes.     

The Construction of Complementarity in Physical Education

This paper discusses the ways in which feminine and masculine subjectivities are constructed as complementary-that is, defined in opposition to one another. This concept will be explored in the context of secondary physical education through an analysis of open-ended interviews with students and teachers as they talk about themselves and each other in relation to physical activity and their expectations of masculine and feminine bodies. It will be argued that physical education is an important location in and through which bodies are inscribed with gender differences which contribute to the marginalisation of girls in relation to physical activity and help to inscribe the female body as lacking those qualities associated with the active male body.     

Willingness toward organ and body donation among anatomy professors and students in Mexico

Most anatomists agree that cadaver dissection serves as a superior teaching tool in human anatomy education. However, attitudes toward body donation vary widely between different individuals. A questionnaire was developed to determine the attitudes toward body and organ donation among those who learn the most from cadavers: medical students, medical student teaching assistants, medical students involved in research, and anatomy professors. A cross‐sectional, prospective study was designed in which the questionnaire was distributed among first‐year human anatomy students before undertaking cadaver dissection at the beginning of the semester, and then again after a commemoration service at the end of the course. The questionnaire items included demographic data, as well as questions designed to characterize participants' attitudes regarding body/organ donation from strangers, family members, and whether participants would consider such practices with their own bodies. Out of a total of 517 students enrolled in the Human Anatomy course in the Medical School at the Universidad Autónoma de Nuevo León, Mexico during January to June 2016, 95% responded to the first (491) and second (490) surveys. Participants' opinions on their own organ donation was similar before and after exposure to cadaver dissection, with between 87% and 81% in favor of such practices, and only 3% against it, in both surveys. Participants' willingness to donate their own bodies, as well as those of family members, increased, while reluctance regarding such practices decreased by half (P < 0.0001 and P < 0.05). Professors had the highest rates of positive opinions regarding their own body donation (74.9%), with 18.8% undecided. Low opposition toward organ and body donation remains prevalent among both anatomists and physicians in training in Mexico. Anat Sci Educ 10: 589–597. © 2017 American Association of Anatomists.     

Interprofessional education in gross anatomy: Experience with first‐year medical and physical therapy students at Mayo Clinic

Interprofessional education (IPE) in clinical practice is believed to improve outcomes in health care delivery. Integrating teaching and learning objectives through cross discipline student interaction in basic sciences has the potential to initiate interprofessional collaboration at the early stages of health care education. Student attitudes and effectiveness of IPE in the context of a combined gross anatomy course for first‐year students in Doctor of Physical Therapy (DPT) and Doctor of Medicine (MD) degrees curricula were evaluated. Integrated teams of MD and DPT students participated in part of the gross anatomy dissection course at Mayo Medical School. A survey was administered to 42 MD and 28 DPT students that assessed their attitudes toward IPE and cooperation among health care professionals. Pre‐ and post‐experience surveys were evaluated. Positive comments were related to opportunities for developing a better understanding of the nature and scope of each other's programs, encouraging teamwork and communication, mutual respect, and reducing the perceptual divide between disciplines. Ninety‐two percent of the students agreed that interprofessional learning would help them in becoming a more effective member of the health care team. This initial experience with IPE in gross anatomy provides a basis for continued development of interdisciplinary educational strategies. Anat Sci Ed 1:258–263, 2008. © 2008 American Association of Anatomists.     

Singapore's anatomical future: Quo Vadis?

The disciplines of anatomy and surgery are not dichotomous since one is dependent on the other. Traditionally, surgeons predominantly taught gross and clinical anatomy. In this review, we examine the context of how human anatomy is taught nowadays. In essence, we discovered that there are certain discernable trends consistently observable between the American and British systems. In Singapore, the British Russell Group first influenced its education landscape but now more so by the American Ivy League. Singapore now has three medical schools all offering differing anatomy curricula, which serves as an opportune time for it to consider if there is a best approach given that the practice of surgery is also evolving in parallel. This review discusses the various pedagogies and issues involved, and will serve as a forum and stimulus for discussion. By tweaking the curriculum correctly and the lessons learnt, future doctors and surgeons in training will receive a better anatomical education, not just in Singapore but the world in general. Key recommendations include the use of body painting, clay, plasticine to facilitate the learning of anatomy, and the implementation of a body donation program. Furthermore, strategic mergers with key stakeholders will also ensure the survival of the discipline.     

The gross anatomy course: An analysis of its importance

The gross anatomy dissection course is a cost‐intensive piece of undergraduate medical education that students and professionals alike describe as very important within the overall medical curriculum. We sought to understand more explicitly students' valuation of gross anatomy as an “important” course and so developed a quantitative longitudinal questionnaire. Medical students (n = 124) enrolled in the winter term 2006/2007 gross anatomy course at the Ulm University Faculty of Medicine were surveyed anonymously prior to, in the middle of, and at the end of the dissection course. Subgroups of students expressing rising or falling opinions of course value were identified and correlated with student opinions about the course's ability to convey professional competencies. Five‐point Likert scales were used for each survey item, which included such standardized instruments as the NeoFFI, BSI, and FBM. The study confirmed that medical students believe dissection to be valuable. Students indicated that participation in the course facilitated acquisition of anatomy knowledge as well as skills related to teamwork, coping with stress, and, to a lesser extent, time management. Students also noted that they developed less empathy than expected beforehand. Significant subgroup differences were observed relative to the competencies of teamwork, stress coping strategies, and empathy, as well as in students' stress levels associated with having to take a dissection course. Our study builds on previous work that has shown dissection courses help students develop professional competencies. The increase in professionalism might be a reason for the generally high value students place on the gross anatomy dissection course, Anat Sci Educ 3:3–11, 2010. © 2010 American Association of Anatomists.