The use of educational comics in learning anatomy among multiple student groups

Understanding basic human anatomy can be beneficial for all students, regardless of when, or if, they will later undertake a formal course in the subject. For students who are preparing to undertake a formal anatomy course, educational comics on basic anatomy can serve as a concise and approachable review of the material. For other students, these comics can serve as a helpful and fun introduction to the human body. The objective of the comics in this study was to promote an understanding of fundamental human anatomy through self‐learning among students. Based on the authors' previous teaching experience, these anatomy comics were produced in a simple, direct style. The comics were titled after the two main characters, “Anna” (a girl) and “Tommy” (a boy). These comics were then presented to groups of elementary school students, high school students, premedical students, and medical students to assess the comics' ability to enhance student interest and comprehension of basic anatomy. Quiz scores among high school students and premedical students were significantly higher among participants who read the educational comics, indicating a deeper comprehension of the subject. Among medical students, close reading of the comics was associated with improved course grades. These educational anatomy comics may be helpful tools to enrich a broad spectrum of different students in learning basic human anatomy. Anat Sci Educ 10: 79–86. © 2016 American Association of Anatomists.     

The importance of exposure to human material in anatomical education: A philosophical perspective

Despite reductions in the importance, time committed to, and status of anatomical education in modern medical curricula, anatomical knowledge remains a cornerstone of medicine and related professions. Anatomists are therefore presented with the challenge of delivering required levels of core anatomical knowledge in a reduced time‐frame and with fewer resources. One common response to this problem is to reduce the time available for students to interact with human specimens (either via dissection or handling of prosected material). In some curricula, these sessions are replaced with didactic or problem‐based approaches focussed on transmitting core anatomical concepts. Here, I propose that the adoption of philosophical principles concerning the relationship and differences between “direct experience” and “concept” provides a strong case in support of requiring students to gain significant exposure to human material. These insights support the hypothesis that direct experience of human material is required for “deep,” rather than “superficial,” understanding of anatomy. Anat Sci Ed 1:264–266, 2008. © 2008 American Association of Anatomists.     

An approach toward the development of core syllabuses for the anatomical sciences

There is increasingly a call for clinical relevance in the teaching of the biomedical sciences within all health care programs. This presupposes that there is an understanding of what is “core” material within the curriculum. To date, the anatomical sciences have been poorly served by the development of core syllabuses, although there have been commendable attempts to define a core syllabus for gross anatomy in medicine and for some medical specialties. The International Federation of Associations of Anatomists and the European Federation for Experimental Morphology aim to formulate, on an international basis, core syllabuses for all branches of the anatomical sciences. This is being undertaken at the initial stage using Delphi Panels consisting of a team of anatomists, scientists, and clinicians who evaluate syllabus content and accord each element/topic “essential,” “important,” “acceptable,” or “not required” status. Their initial conjectures, published on the International Federation of Associations of Anatomists' website, provide merely a framework to enable anatomical (and other cognate learned) societies and individual anatomists, clinicians, and students to comment upon the syllabuses. This article presents the concepts and methodological approaches underlying the hybrid Delphi process employed. Preliminary findings relating to the development of a neuroanatomy core syllabus are provided to illustrate the methods initially employed by a Delphi Panel. The approach is novel in that it is international in scope, is conceptually democratic, and is developmentally fluid in terms of availability for amendment. The aim is to set internationally recognized standards and thus to provide guidelines concerning anatomical knowledge when engaged in course development. Anat Sci Educ 7: 302–311. © 2014 American Association of Anatomists.     

Anatomy education for medical students in the United Kingdom and Republic of Ireland in 2019: A 20-year follow-up

Anatomical education in the United Kingdom (UK) and Ireland has long been under scrutiny, especially since the reforms triggered in 1993 by the General Medical Council's “Tomorrow's Doctors.” The aim of the current study was to investigate the state of medical student anatomy education in the UK and Ireland in 2019. In all, 39 medical schools completed the survey (100% response rate) and trained 10,093 medical students per year cohort. The teachers comprised 760 individuals, of these 143 were employed on full-time teaching contracts and 103 were employed on education and research contracts. Since a previous survey in 1999, the number of part-time staff has increased by 300%, including a significant increase in the number of anatomy demonstrators. In 2019, anatomy was predominantly taught to medical students in either a system-based or hybrid curriculum. In all, 34 medical schools (87%) used human cadavers to teach anatomy, with a total of 1,363 donors being used per annum. Gross anatomy teaching was integrated with medical imaging in 95% of medical schools, embryology in 81%, living anatomy in 78%, neuroanatomy in 73%, and histology in 68.3%. Throughout their five years of study, medical students are allocated on average 85 h of taught time for gross anatomy, 24 h for neuroanatomy, 24 h for histology, 11 h for living anatomy, and 10 for embryology. In the past 20 years, there has been an average loss of 39 h dedicated to gross anatomy teaching and a reduction in time dedicated to all other anatomy sub-disciplines.     

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.     

Some Methodological Issues with “Draw a Scientist Tests” among Young Children

Children’s stereotypes about scientists have been postulated to affect student science identity and interest in science. Findings from prior studies using “Draw a Scientist Test” methods suggest that students see scientists as largely white, often unattractive, men; one consequence may be that girls and minority students feel a science career is “not like me”. However, a major shortcoming in prior research is that scholars have asked children to draw only scientists, thus making interpretations of earlier research findings ambiguous. We added other professionals to compare how 616 drawings of teachers, scientists, and veterinarians by 206 elementary school children varied by student gender, ethnicity, and grade. Students made clear distinctions: drawing teachers as most attractive and largely female, and scientists as most often male and least attractive. Aspects of the drawings suggest that scientists do have an “image problem” among children. However, large sex differences in the drawings and often‐unrecognizable gender figures in boys’ pictures lead us to question use of the “Draw a Scientist Test” as a projective test among young children.     

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.     

Thinking outside the (voice) box: A case study of students' perceptions of the relevance of anatomy to speech pathology

Speech pathology students readily identify the importance of a sound understanding of anatomical structures central to their intended profession. In contrast, they often do not recognize the relevance of a broader understanding of structure and function. This study aimed to explore students' perceptions of the relevance of anatomy to speech pathology. The effect of two learning activities on students' perceptions was also evaluated. First, a written assignment required students to illustrate the relevance of anatomy to speech pathology by using an example selected from one of the four alternative structures. The second approach was the introduction of brief “scenarios” with directed questions into the practical class. The effects of these activities were assessed via two surveys designed to evaluate students' perceptions of the relevance of anatomy before and during the course experience. A focus group was conducted to clarify and extend discussion of issues arising from the survey data. The results showed that the students perceived some course material as irrelevant to speech pathology. The importance of relevance to the students' “state” motivation was well supported by the data. Although the students believed that the learning activities helped their understanding of the relevance of anatomy, some structures were considered less relevant at the end of the course. It is likely that the perceived amount of content and surface approach to learning may have prevented students from “thinking outside the box” regarding which anatomical structures are relevant to the profession. Anat Sci Ed 2008. © 2008 American Association of Anatomists.     

The Initial Impact of the Anatomical Society Gross Anatomy Core Syllabus for Medicine in the United Kingdom: Student and Teacher Perspectives

“What do students studying medicine need to know” is an important question for curriculum planners, anatomy educators and students. The Core Regional Anatomy Syllabus (CRAS), published by the Anatomical Society in 2016, contains 156 learning outcomes (LOs) and has informed “what needs to be known.” This project explored how CRAS had impacted undergraduate anatomy and anatomists in the United Kingdom. A cross-sectional study was designed in two phases. Phase 1, involved a survey of students in clinical years (N = 164). Phase 2 included a survey of anatomist’s views (n = 50) and focus groups of anatomy educators (N = 16). The students’ perspective showed that specific regions of CRAS are deemed less relevant. These were also the body areas where students perceived their anatomical knowledge to be more deficient. Only 46% (n = 75) of students estimated that they knew over 50% (n = 78) of the LOs. Phase two revealed that all anatomists were aware of the syllabus and 48% (n = 24) had checked the CRAS against their own institutional LOs. Anatomists had shared CRAS with colleagues 64% (n = 32) and students at 34% (n = 17), respectively. Forty-six percent (n = 23) of anatomists reported having changed their teaching in some way because of CRAS. The focus groups generated four key themes: “support for CRAS,” “standardization and validation,” “professional identity,” and “limitations and leverage.” Overall CRAS has been well received and is establishing itself within the anatomical community as the new standard for anatomy teaching for medical students.     

No cuts,no buts: Satisfaction of first-year medical students with a hybrid prosection-based model for learning gross anatomy during the Covid-19 pandemic

Few realized the extent of disruption that the Covid-19 global pandemic would impose upon higher anatomical education. While many institutions were obliged to adopt a fully-remote online model, the New York Institute of Technology College of Osteopathic Medicine strove to develop a curriculum that would allow medical students to receive an in-person anatomy education. A hybrid model that emphasized learning from prosected cadavers and self-study stations was implemented, with the remainder of the students' time directed toward studying at home. Through an anonymous survey aimed at gleaning student satisfaction, this study demonstrates that this hybrid prosection-based anatomy course aligned with student preferences both assuming no health risk (64.6% agreed) and given the current risk of contracting Covid-19 (78.5% agreed). Generally, students felt that their education was equal to that of previous years (Likert scale = 3.24 ± 1.05), fostered an appreciation for anatomy (4.56 ± 0.59), promoted teamwork (4.13 ± 0.85), and prepared them for practical examinations (4.18 ± 0.74). Linear mixed-effect models demonstrated that specific differences in results could be attributed to students' preconceived preferences toward student-led dissections and to past medical training. Importantly, most students “disagree” (1.97 ± 1.00) that they were concerned about the risk of exposure to Covid-19 during in-person anatomy laboratory sessions. Areas requiring improvement were identified by the model, including the provision of access to the cadavers outside of the regularly scheduled laboratory times (3.89 ± 1.08). These findings should be utilized when designing future gross anatomy courses in response to the “new normal”.     

Factors influencing students' decisions to participate in a short “dissection experience” within a systemic anatomy course

Changes in medical education have affected both curriculum design and delivery. Many medical schools now use integrated curricula and a systemic approach, with reduced hours of anatomy teaching. While learning anatomy via dissection is invaluable in educational, professional, and personal development, it is time intensive and supports a regional approach to learning anatomy; the use of prosections has replaced dissection as the main teaching method in many medical schools. In our graduate‐entry medical degree, we use an integrated curriculum, with prosections to teach anatomy systemically. However, to not exclude dissection completely, and to expose students to its additional and unique benefits, we implemented a short “Dissection Experience” at the beginning of Year 2. Students attended three two‐hour anatomy sessions and participated in dissection of the clinically relevant areas of the cubital fossa, femoral triangle, and infraclavicular region. This activity was voluntary and we retrospectively surveyed all students to ascertain factors influencing their decision of whether to participate in this activity, and to obtain feedback from those students who did participate. The main reasons students did not participate were previous dissection experience and time constraints. The reasons most strongly affecting students' decisions to participate related to experience (lack of previous or new) and new skill. Students' responses as to the most beneficial component of the dissection experience were based around practical skills, anatomical education, the learning process, and the body donors. We report here on the benefits and practicalities of including a short dissection experience in a systemic, prosection‐based anatomy course. Anat Sci Educ 6: 225–231. © 2013 American Association of Anatomists.     

Student and recent graduate perspectives on radiological imaging instruction during basic anatomy courses

Recently, faculty at Pritzker School of Medicine, The University of Chicago, have made efforts to improve the depth of radiological anatomy knowledge that students have, but no insights exist as to student and resident opinions of how clinically helpful deep anatomical understanding is. A single‐institution survey of second‐ and fourth‐year medical students and postgraduate year 1–4 residents from 11 specialties, composed of five‐point Likert questions, sample examination questions, and narrative response questions, was distributed in 2015. One hundred seventy‐seven of the 466 potential respondents replied (71 residents and 106 students), response rate 38.0%. No nonresponse bias was present in two separate analyses. Respondents generally favored a superficial “identification” question as more relevant to clinical practice, which was positively associated with increasing clinical experience ρ = 0.357, P < 0.001 by point‐biserial correlation. Students and residents most commonly used self‐directed methods to learn medical imaging during their medical anatomy courses (72.6 and 57.7%, respectively). Small group education was least commonly used by students and residents (45.3 and 39.4%, respectively), but most commonly recommended (62.3 and 69%, respectively). A total of 56.6 and 64.8% of students and residents, respectively, reported that having multiple learning methods was “quite” or “extremely” important. Respondents with more clinical experience were more likely to report that a superficial identification question was more clinically relevant than a question testing deeper radiological anatomy knowledge. Small group learning was preferred among students and residents but was the least commonly employed method of instruction. Both findings contrast starkly with current radiological anatomy instructional understanding and practices. Anat Sci Educ 11: 25–31. © 2017 American Association of Anatomists.     

How Haptics and Drawing Enhance the Learning of Anatomy

Students’ engagement with two-dimensional (2D) representations as opposed to three-dimensional (3D) representations of anatomy such as in dissection, is significant in terms of the depth of their comprehension. This qualitative study aimed to understand how students learned anatomy using observational and drawing activities that included touch, called haptics. Five volunteer second year medical students at the University of Cape Town participated in a six-day educational intervention in which a novel “haptico-visual observation and drawing” (HVOD) method was employed. Data were collected through individual interviews as well as a focus group discussion. The HVOD method was successfully applied by all the participants, who reported an improvement of their cognitive understanding and memorization of the 3D form of the anatomical part. All the five participants described the development of a “mental picture” of the object as being central to “deep learning.” The use of the haptic senses coupled with the simultaneous act of drawing enrolled sources of information that were reported by the participants to have enabled better memorization. We postulate that the more sources of information about an object, the greater degree of complexity could be appreciated, and therefore the more clearly it could be captured and memorized. The inclusion of haptics has implications for cadaveric dissection versus non-cadaveric forms of learning. This study was limited by its sample size as well as the bias and position of the researchers, but the sample of five produced a sufficient amount of data to generate a conceptual model and hypothesis.     

Improved medical student perception of ultrasound using a paired anatomy teaching assistant and clinician teaching model

This study describes a new teaching model for ultrasound (US) training, and evaluates its effect on medical student attitudes toward US. First year medical students participated in hands‐on US during human gross anatomy (2014 N = 183; 2015 N = 182). The sessions were facilitated by clinicians alone in 2014, and by anatomy teaching assistant (TA)‐clinician pairs in 2015. Both cohorts completed course evaluations which included five US‐related items on a four‐point scale; cohort responses were compared using Mann‐Whitney U tests with significance threshold set at 0.05. The 2015 survey also evaluated the TAs (three items, five‐point scale). With the adoption of the TA‐clinician teaching model, student ratings increased significantly for four out of five US‐items: “US advanced my ability to learn anatomy” increased from 2.91 ± 0.77 to 3.35 ± 0.68 (P < 0.0001), “Incorporating US increased my interest in anatomy” from 3.05 ± 0.84 to 3.50 ± 0.71 (P < 0.0001), “US is relevant to my current educational needs” from 3.36 ± 0.63 to 3.54 ± 0.53 (P = 0.015), and “US training should start in Phase I” from 3.36 ± 0.71 to 3.56 ± 0.59 (P = 0.010). Moreover, more than 84% of students reported that TAs enhanced their understanding of anatomy (mean 4.18 ± 0.86), were a valuable part of US training (mean 4.23 ± 0.89), and deemed the TAs proficient in US (mean 4.24 ± 0.86). By using an anatomy TA‐clinician teaching team, this study demonstrated significant improvements in student perceptions of the impact of US on anatomy education and the relevancy of US training to the early stages of medical education. Anat Sci Educ 11: 175–184. © 2017 American Association of Anatomists.     

A preliminary survey of professionalism teaching practices in anatomy education among Indian Medical Colleges

Professionalism and ethics have gained widespread recognition as competencies to be fulfilled, taught, and assessed within medical education. The role of the anatomy course in developed nations has evolved over time and now encompasses multiple domains, including knowledge, skills, and the inculcation of professionalism and ethics. The Medical Council of India recently recommended the integration of professionalism teaching in undergraduate medical curricula. The authors investigated whether the initial orientation lectures and instructions given by faculty at the outset of undergraduate medical anatomy courses throughout India served a “hidden curriculum” regarding professionalism practices, and whether these orientation messages could serve as an early exposure to medical professionalism and ethics for medical students. An online survey was carried out among 102 anatomy faculty members across India requesting details about specific professionalism protocols and instructions regarding behavior in the dissection hall that are routinely given to preclinical students, as well as the importance that they placed on professional behavior. It was found that most faculty members regularly instruct students regarding expected behavior during the anatomy course, including dissection practices. These instructions stress attributes of professionalism like humanism, accountability, and honesty. However, there needs to be a more concentrated effort by educators to prohibit such unprofessional practices like dissection hall photography, and better information is required regarding biomedical waste disposal. Despite the absence of clear guidelines for professionalism teaching in medical education in India, the existing framework of anatomy education provides an opportunity to introduce the concept of professionalism to the first‐year medical student. This opportunity may provide an early foundation for designing a professionalism‐integrated curriculum. Anat Sci Educ 10: 433–443. © 2017 American Association of Anatomists.     

Study skills in anatomy and physiology: Is there a difference?

Many factors influence the way individual students study, including but not limited to: previous coursework, attitudes toward the class (motivation, intimidation, risk, etc.), metacognition, and work schedules. However, little of this research has involved medical students. The present article asks the question, “Do individual medical students study differently for different classes?” Study skills surveys were given to United States medical students at an allopathic medical school and an osteopathic medical school. Students were surveyed near the end of their first year gross anatomy course and again near the end of their first year physiology course. Survey items included Likert scale and open‐ended questions about study habits and basic demographic information. The survey responses were correlated with each student's final grade percentages in the courses. Analysis revealed that the four most common study habits were reviewing lecture notes, taking practice examinations, completing learning exercises, and making drawings and diagrams. The two surveys (anatomy and physiology) from each individual were also compared to see if students reported different study habits in anatomy versus physiology. A negative correlation was found between changing study habits between courses and final anatomy grade percentages. Additional analyses suggest that those students who do change their study habits between courses are increasing the number of study strategies that they attempt. This increase in the number of study strategies attempted may not allow the student to reach the same depth of understanding as their colleagues who utilize fewer strategies. Anat Sci Educ. © 2015 American Association of Anatomists.     

Building Professionalism in Human Dissection Room as a Component of Hidden Curriculum Delivery: A Systematic Review of Good Practices

The core values in medical practice which are essential for the humane outlook of a physician are clubbed within the domain of medical professionalism. Professionalism along with other discipline-independent skills (human skills) is propagated implicitly in medical schools as components of a “hidden curriculum.” Evidence suggests a strong association between “hidden curriculum” delivery and development of professionalism in the human dissection room. In this review article, the authors have tried to highlight a few exclusive practices adopted by medical schools which enhance the implementation of the “hidden curriculum” within the practice of human dissection and successfully inculcate the key components of professionalism such as integrity, respect, and compassion among students. These distinctive concepts are aimed at humanizing the experience of anatomical dissection by revealing the identity of the donors along with their personal details either through display of video clips of donor interviews, interactions with the family members of the donor over a meal or recognition of the donor as a mentor and organizing memorial services in honor of donors after conclusion of the dissection in the presence of their family members. The resounding success of these good practices in building professionalism among medical students from the onset of the academic curriculum has signaled a new chapter in anatomical sciences education. It has become imperative to recognize the visionary efforts of a select few medical educators and begin incorporating these recent trends into the delivery of the “hidden curriculum” within the evolving gross anatomy education model.     

Introducing Children to Anatomy: “Getting to Know Our Bodies: The First Step Toward Becoming a Scientist”

Museums are used in every discipline to collect, classify, and present information for scientific purposes. They also serve as an effective educational medium. Since the establishment of a boutique anatomy museum at Bahçeşehir University, lectures, conferences, and seminars have been organized there over the past four years on the history of human anatomy and the human body. In order to raise awareness about the need to make anatomy accessible to kindergarteners and school-aged children, rather than exclusively to undergraduate students, activities that are suited to a wide range of ages have been developed at the museum and at the anatomy laboratory. Four different sessions were conducted, including activities such as lectures using plastic models as props, shaping organs out of playdough, anatomy puzzles, watching cartoons, and examining specimens through a microscope. Healthy and pathologic anatomies were chosen to match daily themes. Among the kindergarteners and elementary school children, no grading was done, nor was any questionnaire administered; however, a survey was administered in the 10–12 age group (N = 64). According to the students' written feedback, 93.75% said they “are happy with microscope activities” while 84.37% said they “had so much fun” participating in the playdough activities. However, 18.75% criticized the activities, saying they “could have been longer.” In conclusion, it is believed that these “getting to know our bodies” activities that were hosted in the anatomy museum, including conferences, workshops, material preparation, and instructional movies, may play an important role in the development of a healthy society.     

An integrated teaching method of gross anatomy and computed tomography radiology

It is essential for medical students to learn and comprehend human anatomy in three dimensions (3D). With this in mind, a new system was designed in order to integrate anatomical dissections with diagnostic computed tomography (CT) radiology. Cadavers were scanned by CT scanners, and students then consulted the postmortem CT images during cadaver dissection to gain a better understanding of 3D human anatomy and diagnostic radiology. Students used handheld digital imaging and communications in medicine viewers at the bench‐side (OsiriX on iPod touch or iPad), which enabled “pixel‐to‐tissue” direct comparisons of CT images and cadavers. Students had lectures and workshops on diagnostic radiology, and they completed study assignments where they discussed findings in the anatomy laboratory compared with CT radiology findings. This teaching method for gross and radiological anatomy was used beginning in 2009, and it yielded strongly positive student perspectives and significant improvements in radiology skills in later clinical courses. Anat Sci Educ 7: 438–449. © 2014 American Association of Anatomists.