Effects of image‐based and text‐based active learning exercises on student examination performance in a musculoskeletal anatomy course

Research on the benefits of visual learning has relied primarily on lecture‐based pedagogy, but the potential benefits of combining active learning strategies with visual and verbal materials on learning anatomy has not yet been explored. In this study, the differential effects of text‐based and image‐based active learning exercises on examination performance were investigated in a functional anatomy course. Each class session was punctuated with an average of 12 text‐based and image‐based active learning exercises. Participation data from 231 students were compared with their examination performance on 262 questions associated with the in‐class exercises. Students also rated the helpfulness and difficulty of the in‐class exercises on a survey. Participation in the active learning exercises was positively correlated with examination performance (r = 0.63, P < 0.001). When controlling for other key demographics (gender, underrepresented minority status) and prior grade point average, participation in the image‐based exercises was significantly correlated with performance on examination questions associated with image‐based exercises (P < 0.001) and text‐based exercises (P < 0.01), while participation in text‐based exercises was not. Additionally, students reported that the active learning exercises were helpful for seeing images of key ideas (94%) and clarifying key course concepts (80%), and that the image‐based exercises were significantly less demanding, less hard and required less effort than text‐based exercises (P < 0.05). The findings confirm the positive effect of using images and active learning strategies on student learning, and suggest that integrating them may be especially beneficial for learning anatomy. Anat Sci Educ 10: 444–455. © 2017 American Association of Anatomists.     

Problem‐based learning in regional anatomy education at Peking University

Problem‐based learning (PBL) has been introduced to medical schools around the world and has increasingly become a popular pedagogical technique in Asian countries since 1990. Gross anatomy is a fundamental basic science course in virtually all medical training programs, and the methods used to teach it are under frequent scrutiny and revision. Students often struggle with the vast collection of new terms and complex relationships between structures that they must learn. To help students with this process, our department teaches separate systemic and regional anatomy courses, the latter in a PBL format. After three years of using PBL in our regional anatomy course, we have worked out a set of effective instructions that we would like to share with other medical schools. We report here evidence that our clinical PBL approach stimulates students' interest in learning and enhances anatomy education in a way that can foster better practices in our future medical work force. Anat Sci Educ. © 2010 American Association of Anatomists.     

Evaluation of an innovative hands‐on anatomy‐centered ultrasound curriculum to supplement graduate gross anatomy education

Ultrasound (US) can enhance anatomy education, yet is incorporated into few non‐medical anatomy programs. This study is the first to evaluate the impact of US training in gross anatomy for non‐medical students in the United States. All 32 master's students enrolled in gross anatomy with the anatomy‐centered ultrasound (ACUS) curriculum were recruited. Mean Likert ratings on pre‐ and post‐course surveys (100% response rates) were compared to evaluate the effectiveness of the ACUS curriculum in developing US confidence, and gauge its impact on views of US. Post‐course, students reported significantly higher (P < 0.001) mean confidence ratings in five US skills (pre‐course versus post‐course mean): obtaining scans (3.13 ±1.04 versus 4.03 ±0.78), optimizing images (2.78 ±1.07 versus 3.75 ±0.92), recognizing artifacts (2.94 ±0.95 versus 3.97 ±0.69), distinguishing tissue types (2.88 ±0.98 versus 4.09 ±0.69), and identifying structures (2.97 ±0.86 versus 4.03 ±0.59), demonstrating the success of the ACUS curriculum in students with limited prior experience. Views on the value of US to anatomy education and to students' future careers remained positive after the course. End‐of‐semester quiz performance (91% response rate) provided data on educational outcomes. The average score was 79%, with a 90% average on questions about distinguishing tissues/artifacts, demonstrating positive learning outcomes and retention. The anatomy‐centered ultrasound curriculum significantly increased confidence with and knowledge of US among non‐medical anatomy students with limited prior training. Non‐medical students greatly value the contributions that US makes to anatomy education and to their future careers. It is feasible to enhance anatomy education outside of medical training by incorporating US. Anat Sci Educ 10: 348–362. © 2016 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.     

The integration of an anatomy massive open online course (MOOC) into a medical anatomy curriculum

Massive open online courses (MOOCs) are designed as stand‐alone courses which can be accessed by any learner around the globe with only an internet‐enabled electronic device required. Although much research has focused on the enrolment and demographics of MOOCs, their impact on undergraduate campus‐based students is still unclear. This article explores the impact of integrating an anatomy MOOC in to the anatomy curriculum of a year 1 medical degree program at the University of Leeds, United Kingdom. The course did not replace any teaching that was already being delivered, and was used to supplement this teaching to support the students' consolidation and revision. Analysis of student feedback indicates a high level of usage, with evidence to suggest that female learners may have approached the course in a more personalized manner. Although the video based resources and quizzes were greatly appreciated as learning tools, significant evidence suggests the students did not engage, or were inclined to engage, with the discussion fora. Furthermore, a significant majority of students did not want the MOOC to replace the existing teaching they received. Given the feedback provided, this research suggests that although the student population believe there to be value in having access to MOOC material, their role as replacements to campus‐based teaching is not supported. Details regarding the enrolment and engagement of the general public with the MOOC during the two runs are also documented, with the suggestion that graduates employed in the healthcare sector were the primary users of the course. Anat Sci Educ 10: 53–67. © 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.     

A survey of student perceptions of team‐based learning in anatomy curriculum: Favorable views unrelated to grades

Team‐based learning (TBL) combines independent out of class preparation with in class small group discussion. We adopted TBL in teaching first year medical gross anatomy. In this study, we evaluated student perceptions of TBL by using a survey that elicited perceptions of both pedagogy and mode of learning. Anatomy lectures were replaced with required preclass readings, self‐assessment quizzes, small group discussions of assignments, and groups retaking the same quizzes for deeper learning. At the course conclusion, students were surveyed to assess their preference for TBL, their perceptions of TBL effectiveness, and their perceptions of successful interpersonal relationships within groups. Respondents (n = 317; 89% response) were asked to rate the extent that they agreed (?2 = strongly disagree; ?1 = disagree; 0 = neutral; 1 = agree; and 2 = strongly agree). A principal components factor analysis with varimax rotation identified two 8‐item factors: “perceptions of TBL” and “perceptions of teamwork.” Internal consistency for each was high [Cronbach's alpha = 0.908 (preference for TBL); 0.884 (preference of teamwork)]. Results of one‐way analysis of variance between Honors/High Pass/Pass/Fail students indicated that Honors (n = 73) tended to rate perceptions of TBL higher than Pass (n = 54) [mean difference = 2.92; 95% CI (0.05, 5.79)], and also higher than Fail (n = 11) [mean difference = 6.30; 95% CI (1.13, 11.47)]. However, each had overallpositive ratings. No difference was noted between mean ratings of teamwork, which were also, overall, positive. We conclude that medical students view TBL favorably irrespective of their grades. Anat Sci Educ 2:150–155, 2009. © 2009 American Association of Anatomists.     

Constructive,collaborative, contextual,and self‐directed learning in surface anatomy education

Anatomy education often consists of a combination of lectures and laboratory sessions, the latter frequently including surface anatomy. Studying surface anatomy enables students to elaborate on their knowledge of the cadaver's static anatomy by enabling the visualization of structures, especially those of the musculoskeletal system, move and function in a living human being. A recent development in teaching methods for surface anatomy is body painting, which several studies suggest increases both student motivation and knowledge acquisition. This article focuses on a teaching approach and is a translational contribution to existing literature. In line with best evidence medical education, the aim of this article is twofold: to briefly inform teachers about constructivist learning theory and elaborate on the principles of constructive, collaborative, contextual, and self‐directed learning; and to provide teachers with an example of how to implement these learning principles to change the approach to teaching surface anatomy. Student evaluations of this new approach demonstrate that the application of these learning principles leads to higher student satisfaction. However, research suggests that even better results could be achieved by further adjustments in the application of contextual and self‐directed learning principles. Successful implementation and guidance of peer physical examination is crucial for the described approach, but research shows that other options, like using life models, seem to work equally well. Future research on surface anatomy should focus on increasing the students' ability to apply anatomical knowledge and defining the setting in which certain teaching methods and approaches have a positive effect. Anat Sci Educ 6: 114–124. © 2012 American Association of Anatomists.     

Measuring learning gain: Comparing anatomy drawing screencasts and paper‐based resources

The use of technology‐enhanced learning (TEL) resources is now a common tool across a variety of healthcare programs. Despite this popular approach to curriculum delivery there remains a paucity in empirical evidence that quantifies the change in learning gain. The aim of the study was to measure the changes in learning gain observed with anatomy drawing screencasts in comparison to a traditional paper‐based resource. Learning gain is a widely used term to describe the tangible changes in learning outcomes that have been achieved after a specific intervention. In regard to this study, a cohort of Year 2 medical students voluntarily participated and were randomly assigned to either a screencast or textbook group to compare changes in learning gain across resource type. Using a pre‐test/post‐test protocol, and a range of statistical analyses, the learning gain was calculated at three test points: immediate post‐test, 1‐week post‐test and 4‐week post‐test. Results at all test points revealed a significant increase in learning gain and large effect sizes for the screencast group compared to the textbook group. Possible reasons behind the difference in learning gain are explored by comparing the instructional design of both resources. Strengths and weaknesses of the study design are also considered. This work adds to the growing area of research that supports the effective design of TEL resources which are complimentary to the cognitive theory of multimedia learning to achieve both an effective and efficient learning resource for anatomical education. Anat Sci Educ 10: 307–316. © 2016 American Association of Anatomists.     

Visuospatial anatomy comprehension: The role of spatial visualization ability and problem‐solving strategies

The present study explored the problem‐solving strategies of high‐ and low‐spatial visualization ability learners on a novel spatial anatomy task to determine whether differences in strategies contribute to differences in task performance. The results of this study provide further insights into the processing commonalities and differences among learners beyond the classification of spatial visualization ability alone, and help elucidate what, if anything, high‐ and low‐spatial visualization ability learners do differently while solving spatial anatomy task problems. Forty‐two students completed a standardized measure of spatial visualization ability, a novel spatial anatomy task, and a questionnaire involving personal self‐analysis of the processes and strategies used while performing the spatial anatomy task. Strategy reports revealed that there were different ways students approached answering the spatial anatomy task problems. However, chi‐square test analyses established that differences in problem‐solving strategies did not contribute to differences in task performance. Therefore, underlying spatial visualization ability is the main source of variation in spatial anatomy task performance, irrespective of strategy. In addition to scoring higher and spending less time on the anatomy task, participants with high spatial visualization ability were also more accurate when solving the task problems. Anat Sci Educ 7: 280–288. © 2013 American Association of Anatomists.     

Spatial abilities and anatomy knowledge assessment: A systematic review

Anatomy knowledge has been found to include both spatial and non‐spatial components. However, no systematic evaluation of studies relating spatial abilities and anatomy knowledge has been undertaken. The objective of this study was to conduct a systematic review of the relationship between spatial abilities test and anatomy knowledge assessment. A literature search was done up to March 20, 2014 in Scopus and in several databases on the OvidSP and EBSCOhost platforms. Of the 556 citations obtained, 38 articles were identified and fully reviewed yielding 21 eligible articles and their quality were formally assessed. Non‐significant relationships were found between spatial abilities test and anatomy knowledge assessment using essays and non‐spatial multiple‐choice questions. Significant relationships were observed between spatial abilities test and anatomy knowledge assessment using practical examination, three‐dimensional synthesis from two‐dimensional views, drawing of views, and cross‐sections. Relationships between spatial abilities test and anatomy knowledge assessment using spatial multiple‐choice questions were unclear. The results of this systematic review provide evidence for spatial and non‐spatial methods of anatomy knowledge assessment. Anat Sci Educ 10: 235–241. © 2016 American Association of Anatomists.     

Loosely‐guided,self‐directed learning versus strictly‐guided,station‐based learning in gross anatomy laboratory sessions

Anatomy students studying dissected anatomical specimens were subjected to either a loosely‐guided, self‐directed learning environment or a strictly‐guided, preformatted gross anatomy laboratory session. The current study's guiding questions were: (1) do strictly‐guided gross anatomy laboratory sessions lead to higher learning gains than loosely‐guided experiences? and (2) are there differences in the recall of anatomical knowledge between students who undergo the two types of laboratory sessions after weeks and months? The design was a randomized controlled trial. The participants were 360 second‐year medical students attending a gross anatomy laboratory course on the anatomy of the hand. Half of the students, the experimental group, were subjected without prior warning to station‐based laboratory sessions; the other half, the control group, to loosely‐guided laboratory sessions, which was the course's prevailing educational method at the time. The recall of anatomical knowledge was measured by written reproduction of 12 anatomical names at four points in time: immediately after the laboratory experience, then one week, five weeks, and eight months later. The strictly‐guided group scored higher than the loosely‐guided group at all time‐points. Repeated ANOVA showed no interaction between the results of the two types of laboratory sessions (P = 0.121) and a significant between‐subject effect (P ≤ 0.001). Therefore, levels of anatomical knowledge retrieved were significantly higher for the strictly‐guided group than for the loosely‐guided group at all times. It was concluded that gross anatomy laboratory sessions with strict instructions resulted in the recall of a larger amount of anatomical knowledge, even after eight months. Anat Sci Educ. © 2012 American Association of Anatomists.     

Modernization of an anatomy class: From conceptualization to implementation. A case for integrated multimodal–multidisciplinary teaching

It has become increasingly apparent that no single method for teaching anatomy is able to provide supremacy over another. In an effort to consolidate and enhance learning, a modernized anatomy curriculum was devised by attempting to take advantage of and maximize the benefits from different teaching methods. Both the more traditional approaches to anatomy teaching, as well as modern, innovative educational programs were embraced in a multimodal system implemented over a decade. In this effort, traditional teaching with lectures and dissection was supplemented with models, imaging, computer‐assisted learning, problem‐based learning through clinical cases, surface anatomy, clinical correlation lectures, peer teaching and team‐based learning. Here, we review current thinking in medical education and present our transition from a passive, didactic, highly detailed anatomy course of the past, to a more interactive, as well as functionally and clinically relevant anatomy curriculum over the course of a decade. Anat Sci Educ. © 2012 American Association of Anatomists.     

Modified team‐based learning strategy to improve human anatomy learning: A pilot study at the Universidad del Norte in Barranquilla,Colombia

As part of an institutional program sponsored by the Centre for Teaching Excellence at the Universidad del Norte, Barranquilla, Colombia, we developed an educational research study on two sessions of human anatomy in which we combined team‐based learning (TBL) and the use of iPads. Study data included the TBL, assessments applied during the course, student's grades on mid‐term examinations and students' perceptions of their experiences. Students reported a positive attitude toward the use of the TBL sessions, and the results showed a significant improvement in their learning between the first and second sessions. Significantly positive correlations (P < 0.05) were obtained between (a) the individual students' readiness test performance 1 and mid‐term examination 1, (b) the individual readiness test performances from Session 1 to Session 2, and (c) the group readiness test performances from the first and second sessions. These results point to positive learning experiences for these students. Analyses of the students' reflections on their activities also pointed toward future challenges. Anat Sci Educ 7: 399–405. © 2014 American Association of Anatomists.     

Evaluation of computer‐aided instruction in a gross anatomy course: A six‐year study

Web‐based computer‐aided instruction (CAI) has become increasingly important to medical curricula. This multi‐year study investigated the effectiveness of CAI and the factors affecting level of individual use. Three CAI were tested that differed in specificity of applicability to the curriculum and in the level of student interaction with the CAI. Student personality preferences and learning styles were measured using the Meyers Briggs Type Indicator (MBTI) and Kolb's Learning Style Inventory (LSI). Information on “computer literacy” and use of CAI was collected from student surveys. Server logs were used to quantify individual use of respective CAI. There was considerable variability in the level of utilization of each CAI by individual students. Individual use of each CAI differed and was associated with gender, MBTI preferences and learning style, but not with “computer literacy.” The majority of students found the CAI useful for learning and used the CAI by themselves. Students who accessed the CAI resources most frequently scored significantly higher on exams compared with students who never accessed the resources. Our results show that medical students do not uniformly use CAI developed for their curriculum and this variability is associated with various attributes of individual students. Our data also provide evidence of the importance of understanding student preferences and learning styles when implementing CAI into the curriculum. Anat Sci Ed 2:2–8, 2009. © 2009 American Association of Anatomists.     

The use of self‐learning modules to facilitate learning of basic science concepts in an integrated medical curriculum

This study used qualitative and quantitative approaches to evaluate the effectiveness of self‐learning modules (SLMs) developed to facilitate and individualize students' learning of basic medical sciences. Twenty physiology and nineteen microanatomy SLMs were designed with interactive images, animations, narrations, and self‐assessments. Of 41 medical students, 40 students voluntarily completed a questionnaire with open‐ended and closed‐ended items to evaluate students' attitudes and perspectives on the learning value of SLMs. Closed‐ended items were assessed on a five‐point Likert scale (5 = high score) and the data were expressed as mean ± standard deviation. Open‐ended questions further evaluated students' perspectives on the effectiveness of SLMs; student responses to open‐ended questions were analyzed to identify shared patterns or themes in their experience using SLMs. The results of the midterm examination were also analyzed to compare student performance on items related to SLMs and traditional sessions. Students positively evaluated their experience using the SLMs with an overall mean score of 4.25 (SD ± 0.84). Most students (97%) indicated that the SLMs improved understanding and facilitated learning basic science concepts. SLMs were reported to allow learner control, to help in preparation for subsequent in‐class discussion, and to improve understanding and retention. A significant difference in students' performance was observed when comparing SLM‐related items with non‐SLM items in the midterm examination (P < 0.05). In conclusion, the use of SLMs in an integrated basic science curriculum has the potential to individualize the teaching and improve the learning of basic sciences. Anat Sci Educ 3: 219–226, 2010. © 2010 American Association of Anatomists.     

“Applying anatomy to something I care about”: Authentic inquiry learning and student experiences of an inquiry project

Despite advances to move anatomy education away from its didactic history, there is a continued need for students to contextualize their studies to make learning more meaningful. This article investigates authentic learning in the context of an inquiry‐based approach to learning human gross anatomy. Utilizing a case‐study design with three groups of students (n = 18) and their facilitators (n = 3), methods of classroom observations, interviews, and artifact collection were utilized to investigate students' experiences of learning through an inquiry project. Qualitative data analysis through open and selective coding produced common meaningful themes of group and student experiences. Overall results demonstrate how the project served as a unique learning experience where learners engaged in the opportunity to make sense of anatomy in context of their interests and wider interdisciplinary considerations through collaborative, group‐based investigation. Results were further considered in context of theoretical frameworks of inquiry‐based and authentic learning. Results from this study demonstrate how students can engage anatomical understandings to inquire and apply disciplinary considerations to their personal lives and the world around them. Anat Sci Educ 10: 538–548. © 2017 American Association of Anatomists.     

Implementation and modification of an anatomy‐based integrated curriculum

Morehouse School of Medicine elected to restructure its first‐year medical curriculum by transitioning from a discipline‐based to an integrated program. The anatomy course, with regional dissection at its core, served as the backbone for this integration by weaving the content from prior traditional courses into the curriculum around the anatomy topics. There were four primary goals for this restructuring process. Goal 1: develop new integrated courses. Course boundaries were established at locations where logical breaks in anatomy content occurred. Four new courses were created, each containing integrated subject content. Goal 2: establish a curriculum management team. The team consisted of course directors, subject specialists, and a curriculum director. This team worked together to efficiently manage the new curriculum. Goal 3: launch contemporary examination and question banking methods. An electronic system, in which images could be included, was implemented for examinations and quizzes, and for storing and refining questions. Goal 4: ensure equitable distribution of standardized examinations and course grading systems among all courses. Assessments included quizzes, in‐course examinations, and National Board of Medical Examiners^® (NBME^®) Subject Examinations. A standard plan assigned the contribution of each to the final course grade. Significant improvement was seen on subject examinations. Once the obstacles and challenges of integration were overcome, a robust and efficient education program was developed. The curriculum is expected to continue evolving and improving, while retaining full regional dissection as a core element. Anat Sci Educ 10: 262–275. © 2016 American Association of Anatomists.