Properties of publications on anatomy in medical education literature

Publications on anatomy in medical education appear to be largely anecdotal. To explore this, we investigated the literature on anatomy in medical education, aiming first to evaluate the contribution of the literature on anatomy in medical education to "best evidence medical education" (BEME) and second to evaluate the development of this literature toward more "best evidence" between 1985 and 2009. Four databases were searched for publications on anatomy in medical education published between 1985 and 2009, resulting in 525 references. Hundred publications were characterized by five variables (journal category, paper subject, paper category, author perspective, and paper perspective). Statements from these publications were characterized by two variables (category and foundation). The publications contained 797 statements that involved the words "anatomy," "anatomical," or "anatomist." Forty-five percent of the publications contained no explicit research question. Forty percent of the statements made were about "teaching methods" and 17% about "teaching content," 8% referred to "practical value," and 10% to "side effects" of anatomy education. Ten percent of the statements were "positional," five percent "traditional," four percent "self-evident," and two percent referred to "quality of care." Fifty-six percent of the statements had no foundation, 17% were founded on empirical data, and 27% by references. These results substantiated the critical comments about the anecdotal nature of the literature. However, it is encouraging to see that between 1985 and 2009 the number of publications is rising that these publications increasingly focus on teaching methods and that an academic writing style is developing. This suggests a growing body of empirical literature about anatomy education.     

Take away body parts! An investigation into the use of 3D‐printed anatomical models in undergraduate anatomy education

Understanding the three‐dimensional (3D) nature of the human form is imperative for effective medical practice and the emergence of 3D printing creates numerous opportunities to enhance aspects of medical and healthcare training. A recently deceased, un‐embalmed donor was scanned through high‐resolution computed tomography. The scan data underwent segmentation and post‐processing and a range of 3D‐printed anatomical models were produced. A four‐stage mixed‐methods study was conducted to evaluate the educational value of the models in a medical program. (1) A quantitative pre/post‐test to assess change in learner knowledge following 3D‐printed model usage in a small group tutorial; (2) student focus group (3) a qualitative student questionnaire regarding personal student model usage (4) teaching faculty evaluation. The use of 3D‐printed models in small‐group anatomy teaching session resulted in a significant increase in knowledge (P = 0.0001) when compared to didactic 2D‐image based teaching methods. Student focus groups yielded six key themes regarding the use of 3D‐printed anatomical models: model properties, teaching integration, resource integration, assessment, clinical imaging, and pathology and anatomical variation. Questionnaires detailed how students used the models in the home environment and integrated them with anatomical learning resources such as textbooks and anatomy lectures. In conclusion, 3D‐printed anatomical models can be successfully produced from the CT data set of a recently deceased donor. These models can be used in anatomy education as a teaching tool in their own right, as well as a method for augmenting the curriculum and complementing established learning modalities, such as dissection‐based teaching. Anat Sci Educ 11: 44–53. © 2017 American Association of Anatomists.     

Evaluation of the effectiveness of 3D vascular stereoscopic models in anatomy instruction for first year medical students

The head and neck region is one of the most complex areas featured in the medical gross anatomy curriculum. The effectiveness of using three‐dimensional (3D) models to teach anatomy is a topic of much discussion in medical education research. However, the use of 3D stereoscopic models of the head and neck circulation in anatomy education has not been previously studied in detail. This study investigated whether 3D stereoscopic models created from computed tomographic angiography (CTA) data were efficacious teaching tools for the head and neck vascular anatomy. The test subjects were first year medical students at the University of Mississippi Medical Center. The assessment tools included: anatomy knowledge tests (prelearning session knowledge test and postlearning session knowledge test), mental rotation tests (spatial ability; presession MRT and postsession MRT), and a satisfaction survey. Results were analyzed using a Wilcoxon rank‐sum test and linear regression analysis. A total of 39 first year medical students participated in the study. The results indicated that all students who were exposed to the stereoscopic 3D vascular models in 3D learning sessions increased their ability to correctly identify the head and neck vascular anatomy. Most importantly, for students with low‐spatial ability, 3D learning sessions improved postsession knowledge scores to a level comparable to that demonstrated by students with high‐spatial ability indicating that the use of 3D stereoscopic models may be particularly valuable to these students with low‐spatial ability. Anat Sci Educ 10: 34–45. © 2016 American Association of Anatomists.     

Spatial abilities of expert clinical anatomists: comparison of abilities between novices, intermediates, and experts in anatomy

Spatial ability has been found to be a good predictor of success in learning anatomy. However, little research has explored whether spatial ability can be improved through anatomy education and experience. This study had two aims: (1) to determine if spatial ability is a learned or inherent facet in learning anatomy and (2) to ascertain if there is any difference in spatial ability between experts and novices in anatomy. Fifty participants were identified: 10 controls, 10 novices, 10 intermediates, and 20 experts. Participants completed four computerized spatial ability tasks, a visual mental rotation task, categorical spatial judgment task, metric spatial task, and an image-scanning task. The findings revealed that experts (P = 0.007) and intermediates (P = 0.016) were better in the metric spatial task than novices in terms of making more correct spatial judgments. Experts (P = 0.033), intermediates (P = 0.003), and novices (P = 0.004) were better in the categorical spatial task than controls in terms of speed of responses. These results suggest that certain spatial cognitive abilities are especially important and characteristic of work needed in clinical anatomy, and that education and experience contribute to further development of these abilities.     

Computerized grading of anatomy laboratory practical examinations

At the Medical College of Wisconsin, a procedure was developed to allow computerized grading and grade reporting of laboratory practical examinations in the Clinical Human Anatomy course. At the start of the course, first year medical students were given four Lists of Structures. On these lists, numbered items were arranged alphabetically; the items were anatomical structures that could be tagged on a given lab practical examination. Each lab exam featured an anatomy laboratory component and a computer laboratory component. For the anatomy lab component, students moved from one question station to another at timed intervals and identified tagged anatomical structures. As students identified a tagged structure, they referred to a copy of the list (provided with their answer sheet) and wrote the number corresponding to the structure on their answer sheet. Immediately after the anatomy lab component, students were escorted to a computer instruction laboratory where they typed their answer numbers into a secured testing component of a learning management system that recorded their answers for automatic grading. After a brief review of examination scores and item analysis by faculty, exam scores were reported to students electronically. Adding this brief computer component to each lab exam greatly reduced faculty grading time, reduced grading errors and provided faster performance feedback for students without changing overall student performance. Anat Sci Ed 1:220–223, 2008. © 2008 American Association of Anatomists.     

Dual‐extrusion 3D printing of anatomical models for education

Two material 3D printing is becoming increasingly popular, inexpensive and accessible. In this paper, freely available printable files and dual extrusion fused deposition modelling were combined to create a number of functional anatomical models. To represent muscle and bone FilaFlex^3D flexible filament and polylactic acid (PLA) filament were extruded respectively via a single 0.4 mm nozzle using a Big Builder printer. For each filament, cubes (5 mm³) were printed and analyzed for X, Y, and Z accuracy. The PLA printed cubes resulted in errors averaging just 1.2% across all directions but for FilaFlex^3D printed cubes the errors were statistically significantly greater (average of 3.2%). As an exemplar, a focus was placed on the muscles, bones and cartilage of upper airway and neck. The resulting single prints combined flexible and hard structures. A single print model of the vocal cords was constructed which permitted movement of the arytenoids on the cricoid cartilage and served to illustrate the action of intrinsic laryngeal muscles. As University libraries become increasingly engaged in offering inexpensive 3D printing services it may soon become common place for both student and educator to access websites, download free models or 3D body parts and only pay the costs of print consumables. Novel models can be manufactured as dissectible, functional multi‐layered units and offer rich possibilities for sectional and/or reduced anatomy. This approach can liberate the anatomist from constraints of inflexible hard models or plastinated specimens and engage in the design of class specific models of the future. Anat Sci Educ 11: 65–72. © 2017 American Association of Anatomists.     

Perceptions of anatomy education—A student's view

Changes in anatomy education over the last two decades have, in large part, led to less emphasis on gross anatomy in the medical curriculum. This has led many to question whether streamlined anatomy courses truly provide adequate preparation for medical practice. Rather than wondering about the effects of these changes, we should be actively seeking answers and promoting understanding between professors, clinicians, and students about what anatomy education is and what it should be. Anat Sci Ed 1:133–134, 2008. © 2008 American Association of Anatomists.     

Modified use of team‐based learning for effective delivery of medical gross anatomy and embryology

Team‐based learning (TBL) is an instructional strategy that combines independent out‐of‐class preparation for in‐class discussion in small groups. This approach has been successfully adopted by a number of medical educators. This strategy allowed us to eliminate anatomy lectures and incorporate small‐group active learning. Although our strategy is a modified use of classical TBL, in the text, we use the standard terminology of TBL for simplicity. We have modified classical TBL to fit our curricular needs and approach. Anatomy lectures were replaced with TBL activities that required pre‐class reading of assigned materials, an individual self‐assessment quiz, discussion of learning issues derived from the reading assignments, and then the group retaking the same quiz for discussion and deeper learning. Students' performances and their educational experiences in the TBL format were compared with the traditional lecture approach. We offer several in‐house unit exams and a final comprehensive subject exam provided by the National Board of Medical Examiners. The students performed better in all exams following the TBL approach compared to traditional lecture‐based teaching. Students acknowledged that TBL encouraged them to study regularly, allowed them to actively teach and learn from peers, and this served to improve their own exam performances. We found that a TBL approach in teaching anatomy allowed us to create an active learning environment that helped to improve students' performances. Based on our experience, other preclinical courses are now piloting TBL. Anat Sci Ed 1:3–9, 2008. © 2007 American Association of Anatomists.     

An explorative learning approach to teaching clinical anatomy using student generated content

Translating basic sciences into a clinical framework has been approached through the implementation of various teaching techniques aimed at using a patient case scenario to facilitate learning. These techniques present students with a specific patient case and lead the students to discuss physiological processes through analysis of provided data supported by independent learning and research. However, no literature exists that describes a reverse teaching methodology in which students are given disease diagnosis and then asked to construct a patient case. This article discusses an explorative learning approach introduced in the gross anatomy course in which students were asked to use clinical skills and reasoning to create a patient case. The online knowledge‐sharing portal utilizing MediaWiki provided a necessary base for students in completing their task. Teams were given 4 weeks to complete their written online project with weekly feedback provided by 3rd year teaching assistants using the Wiki discussion page. A survey was performed to assess competence regarding a patient write up and oral presentation. Skills that the teams acquired through the completion of this project will benefit future patient interactions. This project also emphasized and reinforced the importance of effective communication, leadership, and teamwork. This study shows that a clinical anatomy project that incorporates explorative learning can be an effective way of introducing students to the skills needed for patient write ups and oral presentations. Furthermore this approach to learning allows students to excel during their clinical years and to correlate anatomy to clinical diagnoses. Anat Sci Ed 1:106–110, 2008. © 2008 American Association of Anatomists.     

A shortage of cadavers: The predicament of regional anatomy education in mainland China

Both in mainland China and around the world, regional anatomy stands as one of the most important basic science courses in medical school curricula. As such, dissection of human cadavers and use of prosected specimens remains the most essential teaching method in anatomy education. However, medical educators have raised increasing concerns about an ongoing shortage of cadavers for medical use in mainland China, a problem which may seriously limit the future development of human anatomy education. Based on a survey on cadaver usage in anatomy education in mainland China, this study found that the cadaver resources of most given medical schools in mainland China are associated with their geographic location, academic ranking, and local support for body donation policies. Effective measures to alleviate this shortage of cadavers may include future efforts to promote national‐level body donation legislation, broader acceptance of body donation among Chinese citizens, and an efficient and humane protocol for body donation. Anat Sci Educ 11: 397–402. © 2018 American Association of Anatomists.     

The impact of interactive,computerized educational modules on preclinical medical education

Interactive computerized modules have been linked to improved retention of material in clinical medicine. This study examined the effects of a new series of interactive learning modules for preclinical medical education, specifically in the areas of quiz performance, perceived difficulty of concepts, study time, and perceived stress level. We randomly allocated 102 medical student volunteers into control and experimental groups. All participants studied selected anatomical and physiologic concepts using existing material (lecture notes, textbooks, etc.), while those in the experimental groups used the new interactive modules as well. All participants completed a quiz to test their knowledge of the assigned concepts and a survey to assess their subjective experiences in studying with the modules. We found a trend toward higher quiz scores in the experimental group relative to the control group, though it did not reach statistical significance (P = 0.31). Perceived concept difficulty was significantly reduced among those who studied with the modules (P < 0.001), and the number of hours spent studying the concepts was significantly increased (P = 0.028). Of those who used the modules, 83% rated them as “very helpful” or “extremely helpful.” No significant differences existed between participants' reported stress levels during the course of the study (P = 0.44). Our data suggest that medical students may learn more effectively and feel less intimidated by difficult concepts when interactive modules supplement traditional instruction. Anat Sci Ed 1:247–251, 2008. © 2008 American Association of Anatomists.     

Development of a computer-assisted cranial nerve simulation from the visible human dataset

Advancements in technology and personal computing have allowed for the development of novel teaching modalities such as online web‐based modules. These modules are currently being incorporated into medical curricula and, in some paradigms, have been shown to be superior to classroom instruction. We believe that these modules have the potential of significantly enriching anatomy education by helping students better appreciate spatial relationships, especially in areas of the body with greater anatomical complexity. Our objective was to develop an online module designed to teach the anatomy and function of the cranial nerves. A three‐dimensional model of the skull, brainstem, and thalamus were reconstructed using data from the Visible Human Project and Amira®. The paths of the cranial nerves were overlaid onto this 3D reconstruction. Videos depicting these paths were then rendered using a “roller coaster‐styled” camera approach. Interactive elements adding textual information and user control were inserted into the video using Adobe Creative Suite® 4, and finally, the module was exported as an Adobe Flash movie to be viewable on Internet browsers. Fourteen Flash‐based modules were created in total. The primary user interface comprises a website encoded in HTML/CSS and contains links to each of the 14 Flash modules as well as a user tutorial. Anat Sci Educ 4: 92–97, 2011. © 2010 American Association of Anatomists.     

Human Anatomy: Let the students tell us how to teach

Anatomy teaching methods have evolved as the medical undergraduate curriculum has modernized. Traditional teaching methods of dissection, prosection, tutorials and lectures are now supplemented by anatomical models and e‐learning. Despite these changes, the preferences of medical students and anatomy faculty towards both traditional and contemporary teaching methods and tools are largely unknown. This study quantified medical student and anatomy faculty opinion on various aspects of anatomical teaching at the Department of Anatomy, University of Bristol, UK. A questionnaire was used to explore the perceived effectiveness of different anatomical teaching methods and tools among anatomy faculty (AF) and medical students in year one (Y1) and year two (Y2). A total of 370 preclinical medical students entered the study (76% response rate). Responses were quantified and intergroup comparisons were made. All students and AF were strongly in favor of access to cadaveric specimens and supported traditional methods of small‐group teaching with medically qualified demonstrators. Other teaching methods, including e‐learning, anatomical models and surgical videos, were considered useful educational tools. In several areas there was disharmony between the opinions of AF and medical students. This study emphasizes the importance of collecting student preferences to optimize teaching methods used in the undergraduate anatomy curriculum. Anat Sci Educ 7: 262–272. © 2013 American Association of Anatomists.     

A psychometric evaluation of the anatomy learning experiences questionnaire and correlations with learning outcomes

The Anatomy Learning Experiences Questionnaire (ALEQ) was designed by Smith and Mathias to explore students' perceptions and experiences of learning anatomy. In this study, the psychometric properties of a slightly altered 34‐item ALEQ (ALEQ‐34) were evaluated, and correlations with learning outcomes investigated, by surveying first‐ and second‐year undergraduate medical students; 181 usable responses were obtained (75% response rate). Psychometric analysis demonstrated overall good reliability (Cronbach's alpha of 0.85). Exploratory factor analysis yielded a 27‐item, three‐factor solution (ALEQ‐27, Cronbach's alpha of 0.86), described as: (Factor 1) (Reversed) challenges in learning anatomy, (Factor 2) Applications and importance of anatomy, and (Factor 3) Learning in the dissection laboratory. Second‐year students had somewhat greater challenges and less positive attitudes in learning anatomy than first‐year students. Females reported slightly greater challenges and less confidence in learning anatomy than males. Total scores on summative gross anatomy examination questions correlated with ALEQ‐27, Pearson's r = 0.222 and 0.271, in years 1 and 2, respectively, and with Factor 1, r = 0.479 and 0.317 (all statistically significant). Factor 1 also had similar correlations across different question types (multiple choice; short answer or essay; cadaveric; and anatomical models, bones, or radiological images). In a retrospective analysis, Factor 1 predicted poor end‐of‐semester anatomy examination results in year 1 with a sensitivity of 88% and positive predictive value of 33%. Further development of ALEQ‐27 may enable deeper understanding of students' learning of anatomy, and its ten‐item Factor 1 may be a useful screening tool to identify at‐risk students. Anat Sci Educ 10: 514–527. © 2017 American Association of Anatomists.     

The perceived importance of anatomy and neuroanatomy in the practice of speech—Language pathology

The purpose of this study was to examine the application of anatomy and neuroanatomy knowledge to current practice of speech‐language pathology (SLP), based on the perceptions of practicing SLPs, and to elicit information on participants' experiences of learning these subjects in their primary SLP degree with a view to inform potential curriculum development. A qualitative approach was taken to the collection of data. Eight practicing SLPs from four settings were interviewed. The critical incident technique, together with further probing, was used to elicit information. Interviews were transcribed and later thematically analyzed. This study found that knowledge of anatomy and neuroanatomy was perceived to be important by SLPs across all settings, to varying degrees, with a greater application in acute hospital settings. Negative experiences in studying this material were reported across all settings regardless of country of study. Participants discussed ways to increase students' motivation to learn this challenging material. Relevance of material demanded by students may be enhanced if active learning methods were used to teach anatomy/neuroanatomy, including case‐based learning and with vertical and horizontal integration of material to provide a cohesive, spiral curriculum. Anat Sci Educ. 7: 28–37. © 2013 American Association of Anatomists.     

Collaborative development of anatomy workshops for medical and dental students in Cambodia

After Phnom Penh was liberated from the Khmer Rouge in 1979, health science education in Cambodia had to be completely rebuilt. In this article, the authors report the results of a teaching collaboration between the University of Melbourne (Australia), the International University (Cambodia), and the University of Health Sciences (Cambodia). The main objectives in this collaboration were to provide the opportunity for dental and medical students in Cambodia to attend resourced anatomy workshops and to provide an opportunity for anatomy teachers in Cambodia to gain experience in implementing anatomy workshops of the style that are routinely used in the medical and dental curricula at the University of Melbourne. Experienced anatomy educators from the Department of Anatomy and Cell Biology, University of Melbourne, designed and resourced a series of workshops and then delivered these in collaboration with Cambodian teaching staff in Phnom Penh. The Cambodian students who participated in the workshops were incredibly engaged and enthusiastic. The students' evaluations (by questionnaire) indicated a very positive response to the workshops. All of the workshop resources were donated to the two universities so that the staff could continue to implement similar workshops, and plans were developed to continue our collaboration by developing more resourced workshops for this purpose in the future. Two staff members from Cambodia will travel to Melbourne to participate in anatomy workshops and dissection classes at the University of Melbourne. We hope that this extension of the collaboration provides further support and impetus for the development of anatomy education in Cambodia in the future.     

Student perspectives of imaging anatomy in undergraduate medical education

Radiological imaging is gaining relevance in the acquisition of competencies in clinical anatomy. The aim of this study was to evaluate the perceptions of medical students on teaching/learning of imaging anatomy as an integrated part of anatomical education. A questionnaire was designed to evaluate the perceptions of second‐year students participating in a clinical anatomy course over three consecutive academic years. A principal component analysis was used to evaluate the dimensionality of the questionnaire. The variables were summarized using frequencies, mean, median, 25th percentile, 75th percentile, minimum, and maximum. The results demonstrated that students felt the teaching of imaging anatomy influenced learning in the clinical anatomy course (mean = 4.5, median = 5.0) and subsequent clinical courses (mean = 4.4, median = 4.0). Regarding the imaging techniques used in the demonstration of anatomical structures, computed tomography (median = 5.0) and magnetic resonance imaging (median = 5.0) were highly rated. Students suggested the use of additional support material (37.6%) and favored a more practical approach. In conclusion, the results of this work highlight the value of imaging anatomy in learning human anatomy. Students' comments pointed out a need to focus teaching/learning programs toward a more practical rather than theoretical approach as well as a need to provide a better fit between sectional anatomy and clinical cases using imaging anatomy. In order to provide an optimal learning environment to students, it also seems important to create improved media material as an additional resource tool. Anat Sci Educ. © 2013 American Association of Anatomists.     

Anatomy "steeplechase" online: necessity sometimes is the catalyst for innovation

In most medical schools, summative practical examination in Anatomy usually takes the format of a “steeplechase” (“spotters” or “bell ringers”) conducted in the gross anatomy laboratory using cadaveric material and prosected specimens. Recently, we have started to administer similar examinations online using the quiz facility in WebCT? and Moodle?. This article chronicles how we conceived and developed this method within the peculiar nature of our medical school setting. Over a five year period, practical summative examinations were organized as “steeplechase” online. The online examinations were administered using WebCT? and later Moodle? learning management software. Assessment “objects” were created from the materials available for anatomy teaching. These were digital images of cadaveric materials, radiological, and prosected specimens. In addition, short video clips of 30 seconds duration demonstrating muscle action were produced. These objects were optimized for online viewing and then uploaded onto the learning management software. A bank of questions (multiple choice or short answer type) was then created and linked to the assessment objects. These were used in place of the steeplechase in the computer laboratory. This method serves a crucial purpose in places like ours where continuous availability of human cadavers is impossible. Although time consuming initially, once questions are setup online, future retrieval, and administration becomes convenient especially where there are large batches of students. In addition, the online environment offers distinct advantages with regards to image quality, psychometric analysis of the examination and reduction of staff preparation time compared to traditional “steeplechase.” Anat Sci Educ 4: 115–118, 2011. © 2010 American Association of Anatomists.     

Diffusion of innovations: Smartphones and wireless anatomy learning resources

The author has previously reported on principles of diffusion of innovations, the processes by which new technologies become popularly adopted, specifically in relation to anatomy and education. In presentations on adopting handheld computers [personal digital assistants (PDAs)] and personal media players for health sciences education, particular attention has been directed to the anticipated integration of PDA functions into popular cellular telephones. However, limited distribution of early “smartphones” (e.g., Palm Treo and Blackberry) has provided few potential users for anatomical learning resources. In contrast, iPod media players have been self‐adopted by millions of students, and “podcasting” has become a popular medium for distributing educational media content. The recently introduced Apple iPhone has combined smartphone and higher resolution media player capabilities. The author successfully tested the iPhone and the “work alike” iPod touch wireless media player with text‐based “flashcard” resources, existing PDF educational documents, 3D clinical imaging data, lecture “podcasts,” and clinical procedure video. These touch‐interfaced, mobile computing devices represent just the first of a new generation providing practical, scalable wireless Web access with enhanced multimedia capabilities. With widespread student self‐adoption of such new personal technology, educators can look forward to increasing portability of well‐designed, multiplatform “learn anywhere” resources. Anat Sci Ed 1:233–239, 2008. © 2008 American Association of Anatomists.     

Cinematic Rendering in Anatomy: A Crossover Study Comparing a Novel 3D Reconstruction Technique to Conventional Computed Tomography

Integration of medical imaging into preclinical anatomy courses is already underway in many medical schools. However, interpretation of two-dimensional grayscale images is difficult and conventional volume rendering techniques provide only images of limited quality. In this regard, a more photorealistic visualization provided by Cinematic Rendering (CR) may be more suitable for anatomical education. A randomized, two-period crossover study was conducted from July to December 2018, at the University Hospital of Erlangen, Germany to compare CR and conventional computed tomography (CT) imaging for speed and comprehension of anatomy. Sixteen students were randomized into two assessment sequences. During each assessment period, participants had to answer 15 anatomy-related questions that were divided into three categories: parenchymal, musculoskeletal, and vascular anatomy. After a washout period of 14 days, assessments were crossed over to the respective second reconstruction technique. The mean interperiod differences for the time to answer differed significantly between the CR–CT sequence (−204.21 ± 156.0 seconds) and the CT–CR sequence (243.33 ± 113.83 seconds; P < 0.001). Overall time reduction by CR was 65.56%. Cinematic Rendering visualization of musculoskeletal and vascular anatomy was higher rated compared to CT visualization (P < 0.001 and P = 0.003), whereas CT visualization of parenchymal anatomy received a higher scoring than CR visualization (P < 0.001). No carryover effects were observed. A questionnaire revealed that students consider CR to be beneficial for medical education. These results suggest that CR has a potential to enhance knowledge acquisition and transfer from medical imaging data in medical education.