The anatomy of anatomy: A review for its modernization

Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Until recently, dissection and didactic lectures were its sole pedagogy. Teaching methodology has been revolutionized with more reliance on models, imaging, simulation, and the Internet to further consolidate and enhance the learning experience. Moreover, modern medical curricula are giving less importance to anatomy education and to the acknowledged value of dissection. Universities have even abandoned dissection completely in favor of user‐friendly multimedia, alternative teaching approaches, and newly defined priorities in clinical practice. Anatomy curriculum is undergoing international reformation but the current framework lacks uniformity among institutions. Optimal learning content can be categorized into the following modalities: (1) dissection/prosection, (2) interactive multimedia, (3) procedural anatomy, (4) surface and clinical anatomy, and (5) imaging. The importance of multimodal teaching, with examples suggested in this article, has been widely recognized and assessed. Nevertheless, there are still ongoing limitations in anatomy teaching. Substantial problems consist of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education. Alternative resources and strategies are discussed in an attempt to tackle these genuine concerns. The challenges are to reinstate more effective teaching and learning tools while maintaining the beneficial values of orthodox dissection. The UK has a reputable medical education but its quality could be improved by observing international frameworks. The heavy penalty of not concentrating on sufficient anatomy education will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face dire repercussions. Anat Sci Educ 3: 83–93, 2010. © 2010 American Association of Anatomists.     

The anatomy of accountability

This discussion reconsiders issues of educational accountability. To do so, I report on a qualitative case study of a public elementary school that identified how a model of educational accountability threatened to punish educators through a sophisticated network of surveillance. Data indicated that district personnel used standardized tests to monitor teachers in attempts to coerce them into accepting normalizing judgments of their practice. The study also described the surveillance within the school, including strategies by curriculum developers, reading facilitators, parents, and the principal to monitor teachers’ work. The analysis examined the effects surveillance had on participants and described the ways teachers amplified the effects of surveillance in the school. The analysis rethinks such punitive accountability practices and suggests replacing them with opportunities for teacher education and teacher learning.     

The place of surface anatomy in the medical literature and undergraduate anatomy textbooks

The aims of this review were to examine the place of surface anatomy in the medical literature, particularly the methods and approaches used in teaching surface and living anatomy and assess commonly used anatomy textbooks in regard to their surface anatomy contents. PubMed and MEDLINE databases were searched using the following keywords “surface anatomy,” “living anatomy,” “teaching surface anatomy,” “bony landmarks,” “peer examination” and “dermatomes”. The percentage of pages covering surface anatomy in each textbook was calculated as well as the number of images covering surface anatomy. Clarity, quality and adequacy of surface anatomy contents was also examined. The search identified 22 research papers addressing methods used in teaching surface anatomy, 31 papers that can help in the improvement of surface anatomy curriculum, and 12 anatomy textbooks . These teaching methods included: body painting, peer volunteer surface anatomy, use of a living anatomy model, real time ultrasound, virtual (visible) human dissector (VHD), full body digital x‐ray of cadavers (Lodox^® Statscan^® images) combined with palpating landmarks on peers and the cadaver, as well as the use of collaborative, contextual and self‐directed learning. Nineteen of these studies were published in the period from 2006 to 2013. The 31 papers covered evidence‐based and clinically‐applied surface anatomy. The percentage of surface anatomy in textbooks' contents ranged from 0 to 6.2 with an average of 3.4%. The number of medical illustrations on surface anatomy varied from 0 to 135. In conclusion, although there has been a progressive increase in publications addressing methods used in teaching surface anatomy over the last six to seven years, most anatomy textbooks do not provide students with adequate information about surface anatomy. Only three textbooks provided a solid explanation and foundation of understanding surface anatomy. Anat Sci Educ 6: 415–432. © 2013 American Association of Anatomists.     

Bringing anatomy to life: Evaluating a novel ultrasound curriculum in the anatomy laboratory

As point-of-care ultrasound (POCUS) invades medical specialties, more students covet earlier ultrasound (US) training programs in medical school. Determining the optimal placement and format in the curriculum remains a challenge. This study uses student perceptions and confidence in interpreting and acquiring images to evaluate the effectiveness of an US curriculum and assesses their performance on US content. A unique US curriculum was incorporated into first-year clinical anatomy at Tufts University School of Medicine (TUSM). Students completed surveys evaluating changes in US confidence and perceptions. Mean ratings on pre- and post-surveys were compared using Mann–Whitney U tests. Performance on US examination questions was evaluated. Two independent evaluators coded narrative responses and NVivo software was used to identify common themes. Two hundred eleven students completed the US curriculum. Students reported higher post-curriculum mean confidence ratings on US comprehension, operation, image acquisition, artifact recognition, and normal image interpretation (P < 0.0001). US reinforced anatomy concepts and clinical correlates (9.56, ±0.97 SD; 9.60, ±1.05). Students disagreed with items stating learning US is too difficult (1.2, ±2.2) and that it interferes with learning anatomy (0.68, ±1.7). Students scored above passing on practical US knowledge questions, supporting survey data, and the relation to learning spatial relationships. Qualitative analysis identified seven major themes and additional subthemes. Limited integration of US breaks barriers in students' perceptions and confidence in performing POCUS. The TUSM US curriculum is a natural marriage of anatomy and POCUS applications, serving as a template for medical schools.     

Lecture recording system in anatomy

The literature reports that using Learning Recording Systems (LRS) is usually well received by students but that the pedagogical value of LRS in academic settings remains somewhat unclear. The primary aim of the current study is to document students' perceptions, actual pattern of usage, and impact of use of LRS on students' grade in a dental gross and neuroanatomy course. Other aims are to determine if students' learning preference correlated with final grades and to see if other factors like gender, age, overall academic score on the Dental Aptitude Test (DAT), lecture levels of difficulty, type of lecture, category of lecture, or teaching faculty could explain the impact, if any, of the use of LRS on the course final grade. No significant correlation was detected between the final grades and the variables studied except for a significant but modest correlation between final grades and the number of times the students accessed the lecture recordings (r=0.33 with P=0.01). Also, after adjusting for gender, age, learning style, and academic DAT, a significant interaction between auditory and average usage time was found for final grade (P=0.03). Students who classified themselves as auditory and who used the LRS on average for fewer than 10 minutes per access, scored an average final grade of 16.43 % higher than the nonauditory students using the LRS for the same amount of time per access. Based on these findings, implications for teaching are discussed and recommendations for use of LRS are proposed. Anat Sci Educ 6: 376–384. © 2013 American Association of Anatomists.     

"Digit anatomy": a new technique for learning anatomy using motor memory

Gestural motions of the hands and fingers are powerful tools for expressing meanings and concepts, and the nervous system has the capacity to retain multiple long-term motor memories, especially including movements of the hands. We developed many sets of successive movements of both hands, referred to as "digit anatomy," and made students practice the movements which express (1) the aortic arch, subclavian, and thoracoacromial arteries and their branches, (2) the celiac trunk, superior mesenteric artery and their branches, and formation of the portal vein, (3) the heart and the coronary arteries, and (4) the brachial, lumbar, and sacral plexuses. A feedback survey showed that digit anatomy was helpful for the students not only in memorizing anatomical structures but also in understanding their functions. Out of 40 students, 34 of them who learned anatomy with the help of digit anatomy were "very satisfied" or "generally satisfied" with this new teaching method. Digit anatomy that was used to express the aortic arch, subclavian, and thoracoacromial arteries and their branches was more helpful than those representing other structures. Although the movements of digit anatomy are expected to be remembered longer than the exact meaning of each movement, invoking the motor memory of the movement may help to make relearning of the same information easier and faster in the future.     

Learning anatomy enhances spatial ability

Spatial ability is an important factor in learning anatomy. Students with high scores on a mental rotation test (MRT) systematically score higher on anatomy examinations. This study aims to investigate if learning anatomy also oppositely improves the MRT‐score. Five hundred first year students of medicine (n = 242, intervention) and educational sciences (n = 258, control) participated in a pretest and posttest MRT, 1 month apart. During this month, the intervention group studied anatomy and the control group studied research methods for the social sciences. In the pretest, the intervention group scored 14.40 (SD: ± 3.37) and the control group 13.17 (SD: ± 3.36) on a scale of 20, which is a significant difference (t‐test, t = 4.07, df = 498, P < 0.001). Both groups show an improvement on the posttest compared to the pretest (paired samples t‐test, t = 12.21/14.71, df = 257/241, P < 0.001). The improvement in the intervention group is significantly higher (ANCOVA, F = 16.59, df = 1;497, P < 0.001). It is concluded that (1) medical students studying anatomy show greater improvement between two consecutive MRTs than educational science students; (2) medical students have a higher spatial ability than educational sciences students; and (3) if a MRT is repeated there seems to be a test effect. It is concluded that spatial ability may be trained by studying anatomy. The overarching message for anatomy teachers is that a good spatial ability is beneficial for learning anatomy and learning anatomy may be beneficial for students' spatial ability. This reciprocal advantage implies that challenging students on spatial aspects of anatomical knowledge could have a twofold effect on their learning. Anat Sci Educ 6: 257–262. © 2013 American Association of Anatomists.     

The virtual anatomy laboratory: usability testing to improve an online learning resource for anatomy education

An increasing number of instructors are seeking to provide students with online anatomy resources. Many researchers have attempted to identify associations between resource use and student learning but few studies discuss the importance of usability testing in resource design and modification. Usability testing provides information about ease of use and resource flexibility and indicates navigational issues that contribute to extraneous cognitive load for the user. An example of usability testing for modification of an online anatomy resource called the "Virtual Lab" is presented. Usability testing was used to determine whether increased content would impair navigation through the interface. Subjects with varying levels of experience with anatomy content were recruited to assess efficiency and effectiveness (defined by usability standards) of the original resource and of the redesigned resource. Comparisons between usability evaluation of the original "Virtual Lab" (OVL) and of the redesigned "Virtual Lab" (RVL) revealed that subjects were better able to successfully complete tasks using the RVL than they were with the OVL. Results also demonstrated that subjects did not take significantly more time to successfully complete tasks with the RVL. Additionally, usability testing revealed that subjects were able to successfully complete tasks using the RVL regardless of whether they possessed prior experience with anatomy content or not. Results of this study suggest that the modified resource is more effective for users. The example presented here underscores the need for usability testing prior to resource implementation and whenever significant changes are made to a resource interface.     

Musculoskeletal anatomy knowledge in Australian chiropractors

Anatomy is a key knowledge area in chiropractic and is formally offered in the undergraduate component of chiropractic education. There is the potential for loss of anatomy knowledge before the opportunity to apply it in a clinical setting. This study aimed to determine whether chiropractic clinicians retain a level of anatomy knowledge comparable to that of chiropractic students and to compare chiropractors' self-rating of their anatomical knowledge against an objective knowledge assessment tool. A previously validated multiple-choice test was utilized to measure retention of limb musculoskeletal (MSK) knowledge in Australian chiropractors. One hundred and one registered chiropractors completed the questionnaire and responses were scored, analyzed, and compared to scores attained by undergraduate and postgraduate chiropractic students who had previously completed the same questionnaire. The results indicated that practitioners retained their anatomy knowledge, with a significantly higher total mean score than the undergraduate group [total mean score = 36.5% (±SD 13.6%); P < 0.01] but not significantly different to the postgraduate group [total mean score = 52.2% (±SD 14.1%); P = 0.74]. There was a weak positive correlation between chiropractors' self-rated knowledge and test performance scores indicating the effectiveness of this Australian chiropractic group in self-assessing their anatomy knowledge. This study found that Australian chiropractors' knowledge of MSK anatomy was retained during the transition from university to clinical practice and they accurately evaluated their own test performance.     

The anatomy of the RAN-reading relationship

The purpose of this study was to contrast three models of the RAN-reading relationship derived from the most prominent theoretical accounts of how RAN is related to reading: the phonological processing, the orthographic processing and the speed of processing accounts. Grade 4 Greek-speaking children (n = 208; 114 girls, 94 boys; mean age = 117.29 months) were administered measures of general cognitive ability, RAN, phonological processing, orthographic processing, speed of processing, and reading fluency. Phonological processing and orthographic processing were assessed with both accuracy and speeded measures. Structural equation modeling showed that the most parsimonious model was one in which RAN predicted reading fluency directly and through orthographic processing. Phonological processing did not predict reading fluency and speed of processing was more important for the RAN-orthographic/phonological processing relationships than for the RAN-reading relationship. Taken together, these findings suggest that what is unique to RAN is more important for the prediction of reading fluency than what it shares with either speed of processing, phonological processing, or orthographic processing.     

Observations by a university anatomy teacher and a suggestion for curricular change: Integrative anatomy for undergraduates

The observation that anatomical course offerings have decreased in undergraduate biology curricula is supported by a survey of undergraduate institutions in the state of Washington. This reduction, due partially to increased emphasis in other areas of the biology curriculum, along with the lack of anatomy prerequisites for admission to most medical and dental schools, has resulted in many biology majors who have little or no exposure to the anatomical sciences. This is a disservice to our students who need to understand organismal form and function to better connect our rapidly expanding knowledge of life at the cell and molecular level to our understanding of the role of organisms in ecosystems and as the primary target of natural selection in evolutionary change. Undergraduate anatomical courses can also serve as an extension of the anatomy curriculum in professional healthcare programs, where anatomical sciences are also experiencing a reduced allocation of instructional time. Given the importance of anatomical knowledge along with the many demands and constraints on biology curricula, what can we do? One suggestion, a course in integrative anatomy for undergraduates, is proposed and discussed. Anat Sci Educ 3:73–76, 2010. © 2010 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.     

家兔解剖实验改进与拓展

通过对普通生物学实验中家兔解剖实验的探讨,解决了家兔活体解剖教学中的一些关键技术和难点问题,培养了学生对动物解剖的兴趣,加深了学生对哺乳动物的结构、器官和系统的感性认识,有效地培养了学生仔细观察和动手操作的能力.