Tablet-assisted objective structured spotter practical examination (TOSSPE): Advantages of an innovative anatomy spotter examination method for medical student assessment

The affordances of technology-based assessments, like the objectively structured practical examination, have become an integral part of gross anatomy courses. The Department of Anatomy Faculty of Medicine at the University of Warmia and Mazury developed and introduced an application for tablet devices which has been implemented in student examinations and assessments, called the tablet-assisted objective structured spotter practical examination. It was created to simplify the educational process and to build a rich learning environment, facilitating deep learning for students through examination and feedback data. The method consists of cadaver stations with traditional corresponding pin spotters in an expanded tablet application. It not only provides instant feedback on various observations of teaching–learning skills but has also positively affected the entire process of education. The method provides an unbiased evaluation of knowledge and understanding of the anatomy course, ensuring objectivity and standardization. The current study was performed on a total of 608 first-year medical students in Polish and English divisions and focused on the observed advantages since the new method was introduced. Outcomes indicate that after the implementation of the method for both the Polish and English divisions' first-year medical students, the mean score of examinations significantly increased compared to other teaching–learning methods. The study highlights that students were excited about the implementation of the new method and identified its many benefits. It is recognized that technological development and the digital environment offer a range of opportunities and added value versus traditional assessment activities, methods, and processes.     

Participation in Dissection Affects Student Performance on Gross Anatomy Practical and Written Examinations: Results of a Four-Year Comparative Study

The role of human dissection in modern medical curricula has been a topic of intense debate. In part, this is because dissection can be time-consuming and curricular hours are being monitored more carefully. This has led some to question the efficacy and importance of dissection as a teaching method. While this topic has received considerable attention in the literature, the question of how dissection impacts learning has been difficult to evaluate in a real-world, high-stakes setting since participation in dissection is often one of many variables. In this study, this challenge was overcome due to a change in the curriculum of a Special Master Program (SMP) that permitted a comparison between two years of students that learned anatomy using prosection only and two years of students that participated in dissection laboratories. Since each class of SMP students took courses in the medical school, and the medical school anatomy curriculum was constant, medical student performance served as a control throughout the study period. Results demonstrate that SMP students who learned through prosection had lower performance on anatomy practical and written examinations compared to medical students. When the SMP program changed and students started participating in dissection, there were measurable improvements in both practical and written examinations. These findings provide evidence of dissection’s role in learning and applying anatomy knowledge both within and outside the gross anatomy laboratory.     

A Pilot Study of a Physical Therapy Cadaveric Anatomy Course: Assessing the Impact of Examination Format on the Learning Environment

Anatomy education continues to evolve in health professional programs as curricula shift to competency-based models and contact hours decrease. These changes in curricula may significantly alter the learning environment for students. Importantly, changes in learning environment have been shown to impact student learning strategies and well-being. It follows, then, that an investigation of students' perceptions of the learning environment is key to understand the impact of modern anatomy curriculum alterations. The current pilot study evaluated the impact of modifying examination format on the learning environment of physical therapy students participating in a human cadaveric anatomy course. Two study cohorts of first year (entry-level) physical therapy students were invited to complete a preliminary learning environment questionnaire with 13 visual analog scale items and four short answer items. One study cohort was tested with a viva (oral) practical examination, and the other, with a bell-ringer practical examination. Analysis of quantitative items revealed two significant findings: physical therapy students in the bell-ringer cohort found it was more difficult to prepare for their examination, and that they had inadequate time to respond to questions compared to the viva cohort. Analysis of qualitative items revealed distinct themes that concerned physical therapy student learning environment specific to cadaveric anatomy. These results demonstrate that examination format can influence the learning environment of physical therapy students studying cadaveric anatomy. As a result, care needs to be taken to ensure that modernized curricula align the examination format to the method of instruction and the future application of students' knowledge in clinical practice.     

Summative and Formative Style Anatomy Practical Examinations: Do They Have Impact on Students’ Performance and Drive for Learning?

Anatomical knowledge is commonly assessed by practical examinations that are often administered in summative format. The format of anatomy practical examination was changed at the Lee Kong Chian School of Medicine in Singapore from summative (graded; must pass) to formative (ungraded; no pass/fail) in academic year (AY) 2017–2018. Both assessment formats were undertaken online, but the formative mode used a team-based learning activity comprising individual and team assessments. This gave an unique opportunity to investigate: (1) the impact of two different online assessment formats on student performance in practical examination; (2) the impact of new formative practical examination on students’ performance in summative examinations; and (3) students’ opinions of these two practical examination formats. The class of 2021 perceptions was obtained as they experienced both formats. A retrospective cohort study was also conducted to analyze the Year 2 students’ performance in anatomy practical and year-end summative examinations of cohorts AY 2015–2016, AY 2016–2017 (summative format), and AY 2017–2018 (formative format). There were no significant differences in students’ performance between two practical examination formats. The cohort who experienced the formative format, performed significantly better in summative examinations (mean ± SD: 82.32 ± 10.22%) compared with the cohort who experienced the summative format (73.77 ± 11.09%) (P < 0.001). Students highlighted positive features of the formative practical examination, including team reinforcement of learning, instant feedback, and enhanced learning. These findings indicate that students continue to study for anatomy practical examination without the need for external drivers. The team-based learning style practical examination enhances students’ performance in summative examinations.     

Active Learning of the Floor of Mouth Anatomy with Ultrasound

More emphasis is now being placed on active learning in medical education. Ultrasound is an active learning tool that can be used to supplement didactic instruction. This study describes a self-guided activity for learning floor of mouth ultrasound. Thirty-three first year medical students learned floor of mouth scan technique and ultrasound anatomy through a brief PowerPoint module. They subsequently performed the scan on a standardized patient. Each student was asked to label the floor of mouth muscles on the image he or she acquired. After the activity, the students were given a quiz on anatomic relationships of the floor of mouth. Perceptions about the activity were collected through a survey. All 33 students obtained a floor of mouth image within a three minute time limit. Twenty-four (73%) students were able to completely and accurately label the image in time. The mean score on the muscle relationships quiz was 93%. Overall perceptions were very positive with most students expressing a “high” or “very high” level of interest in incorporating similar self-guided activities within the curriculum. This study showed that it is feasible for students to learn scan technique and recognize relevant ultrasound anatomy in an independent fashion through a brief active learning module. Furthermore, the students found the activity enjoyable. The implication is that similar activities could be developed which would provide additional ways to incorporate active learning strategies.     

Fear of Death and Examination Performance in a Medical Gross Anatomy Course with Cadaveric Dissection

Cadaveric dissection offers an important opportunity for students to develop their ideas about death and dying. However, it remains largely unknown how this experience impacts medical students' fear of death. The current study aimed to address this gap by describing how fear of death changed during a medical gross anatomy dissection course and how fear of death was associated with examination performance. Fear of death was surveyed at the beginning of the course and at each of the four block examinations using three of the eight subscales from the Multidimensional Fear of Death Scale: Fear of the Dead, Fear of Being Destroyed, and Fear for the Body After Death. One hundred forty-three of 165 medical students (86.7%) completed the initial survey. Repeated measures ANOVA showed no significant changes in Fear of the Dead (F (4, 108) = 1.45, P = 0.222) or Fear for the Body After Death (F (4, 108) = 1.83, P = 0.129). There was a significant increase in students' Fear of Being Destroyed (F (4, 108) = 6.86, P < 0.0005) after beginning dissection. This increase was primarily related to students' decreased willingness to donate their body. Concerning performance, there was one significant correlation between Fear for the Body After Death and the laboratory examination score at examination 1. Students with higher fears may be able to structure their experience in a way that does not negatively impact their performance, but educators should still seek ways to support these students and encourage body donation.     

What is an objective structured practical examination in anatomy?

Assessing teaching‐learning outcomes in anatomical knowledge is a complex task that requires the evaluation of multiple domains: theoretical, practical, and clinical knowledge. In general, theoretical knowledge is tested by a written examination system constituted by multiple choice questions (MCQs) and/or short answer questions (SAQ). The assessment of practical knowledge (three‐dimensional anatomical concepts) involves oral, spot, or objective structured practical examinations (OSPE). Finally, the application of anatomical knowledge to patients is tested mainly through objective structured clinical examinations (OSCE). The major focus of this study is the OSPE. Although many schools challenge students using this tool in practical examinations in the early phase of the curriculum, the true meaning of OSPE is frequently forgotten and it becomes, in reality, a spot examination. This article, for the first time, describes how the concept of the OSPE has evolved and is currently being used to assess the practical domain of anatomical knowledge in a problem‐based curriculum at Alfaisal University College of Medicine. In addition, it describes the main differences from the spot examination, which is normally used in traditional medical curricula. The authors believe that the OSPE remains the most efficient tool to assess the practical aspects of anatomical knowledge in a system where basic knowledge is integrated with the clinical or functional part of anatomy. However, this contention only holds true if the OSPE process revolves around structured objectives. Anat Sci Educ 6: 125–133. © 2012 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.     

Exploring the Utility and Student Perceptions of Synthetic Cadavers in an Undergraduate Human Anatomy Course

The synthetic cadaver is a high-fidelity model intended to replace or supplement other anatomy learning modalities. Academic attainment and student perceptions were examined in an undergraduate human anatomy course using a combination of plastic models and synthetic cadavers to learn lower body anatomy (“Experimental group”), compared to a Historical group who used only plastic models. Grades on an upper body test, for which both groups used only plastic models, were compared to ensure that no academic differences existed between groups (P = 0.7653). Students in the Experimental group performed better on the lower body test for which they used both plastic models and synthetic cadavers (median = 73.8% (95% CI: 72.0%-75.0%) compared to the Historical group (70.1% (95% CI: 68.3%-70.7%), P < 0.0001); however, less than half of students (49%) attributed this to the synthetic cadavers. Students' perception of laboratory resources (P < 0.0001) and learning experience (P < 0.0001) both improved with the addition of synthetic cadavers compared to using only plastic models, and 60% of students in the Experimental group agreed that the synthetic cadavers would be a key reason that they would choose that institution for undergraduate studies. This investigation showed improved student grades when plastic models and synthetic cadavers were combined, in addition to improved student perceptions of the learning experience. Results of the student questionnaires also suggested that although synthetic cadavers carry a notable up-front cost, they may be a useful recruitment tool for institutions.     

Anticipatory Feelings About Dissection: An Exercise for the First Day of a Gross Anatomy Course

Studies have demonstrated that students experience a variety of intense emotions in anticipation of human anatomical dissection, including enthusiasm, gratitude, responsibility, apprehension, detachment, anxiety, and spiritual or moral reflection. The exercise described here provides an opportunity to start a conversation about the complexity of students’ emotional reactions to the anatomy experience. The intention of this exercise is to normalize the variety of emotions that anatomy students experience, both to demonstrate to students that their emotions are normal and to encourage the empathy for others' reactions which may differ from their own. In the lecture hall setting before the first day of dissection, students are asked to draw how they feel about the dissection experience and are provided an opportunity to discuss their drawings with their peers. The course director then provides a slide show demonstration of drawings from previous years, and experienced anatomy faculty facilitate a large group discussion in which students react to the drawing exercise and slide show and ask questions which are addressed by the faculty. This exercise provides an opportunity for students to practice appropriately communicating about emotionally complex experiences in a professional setting. The exercise is straightforward to implement and is easily modifiable for different class sizes and curricular structures.     

Ultrasound and cadaveric prosections as methods for teaching cardiac anatomy: a comparative study

This study compared the efficacy of two cardiac anatomy teaching modalities, ultrasound imaging and cadaveric prosections, for learning cardiac gross anatomy. One hundred and eight first-year medical students participated. Two weeks prior to the teaching intervention, students completed a pretest to assess their prior knowledge and to ensure that groups were equally randomized. Students, divided into pre-existing teaching groups, were assigned to one of two conditions; "cadaver" or "ultrasound." Those in the cadaver group received teaching on the heart using prosections, whereas the ultrasound group received teaching using live ultrasound images of the heart. Immediately after teaching, students sat a post-test. Both teaching modalities increased students' test scores by similar amounts but no significant difference was found between the two conditions, suggesting that both prosections and ultrasound are equally effective methods for teaching gross anatomy of the heart. Our data support the inclusion of either cadaveric teaching or living anatomy using ultrasound within the undergraduate anatomy curriculum, and further work is needed to compare the additive effect of the two modalities.     

Equivalence of students' scores on timed and untimed anatomy practical examinations

Untimed examinations are popular with students because there is a perception that first impressions may be incorrect, and that difficult questions require more time for reflection. In this report, we tested the hypothesis that timed anatomy practical examinations are inherently more difficult than untimed examinations. Students in the Doctor of Physical Therapy program at Thomas Jefferson University were assessed on their understanding of anatomic relationships using multiple‐choice questions. For the class of 2012 (n = 46), students were allowed to circulate freely among 40 testing stations during the 40‐minute testing session. For the class of 2013 (n = 46), students were required to move sequentially through the 40 testing stations (one minute per item). Students in both years were given three practical examinations covering the back/upper limb, lower limb, and trunk. An identical set of questions was used for both groups of students (untimed and timed examinations). Our results indicate that there is no significant difference between student performance on untimed and timed examinations (final percent scores of 87.3 and 88.9, respectively). This result also held true for students in the top and bottom 20th percentiles of the class. Moreover, time limits did not lead to errors on even the most difficult, higher‐order questions (i.e., items with P‐values < 0.70). Thus, limiting time at testing stations during an anatomy practical examination does not adversely affect student performance. Anat Sci Educ 6: 281–285. © 2013 American Association of Anatomists.     

The validity of multiple choice practical examinations as an alternative to traditional free response examination formats in gross anatomy

Traditionally, an anatomy practical examination is conducted using a free response format (FRF). However, this format is resource‐intensive, as it requires a relatively large time investment from anatomy course faculty in preparation and grading. Thus, several interventions have been reported where the response format was changed to a selected response format (SRF). However, validity evidence from those interventions has not proved entirely adequate for the practical anatomy examination, and thus, further investigation was required. In this study, the validity evidence of SRF was examined using multiple choice questions (MCQs) constructed according to different levels of Bloom's taxonomy in comparison with the traditional free response format. A group of 100 medical students registered in a gross anatomy course volunteered to be enrolled in this study. The experimental MCQ examinations were part of graded midterm and final steeplechase practical examination. Volunteer students were instructed to complete the practical examinations twice, once in each of two separate examination rooms. The two separate examinations consisted of a traditional free response format and MCQ format. Scores from the two examinations (FRF and MCQ) displayed a strong correlation, even with higher level Bloom's taxonomy questions. In conclusion, the results of this study provide empirical evidence that the SRF (MCQ) response format is a valid method and can be used as an alternative to the traditional FRF steeplechase examination. Anat Sci Educ. © 2013 American Association of Anatomists.     

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.     

Ultrasound imaging in medical student education: Impact on learning anatomy and physical diagnosis

Ultrasound use has expanded dramatically among the medical specialties for diagnostic and interventional purposes, due to its affordability, portability, and practicality. This imaging modality, which permits real‐time visualization of anatomic structures and relationships in vivo, holds potential for pre‐clinical instruction of students in anatomy and physical diagnosis, as well as providing a bridge to the eventual use of bedside ultrasound by clinicians to assess patients and guide invasive procedures. In many studies, but not all, improved understanding of anatomy has been demonstrated, and in others, improved accuracy in selected aspects of physical diagnosis is evident. Most students have expressed a highly favorable impression of this technology for anatomy education when surveyed. Logistic issues or obstacles to the integration of ultrasound imaging into anatomy teaching appear to be readily overcome. The enthusiasm of students and anatomists for teaching with ultrasound has led to widespread implementation of ultrasound‐based teaching initiatives in medical schools the world over, including some with integration throughout the entire curriculum; a trend that likely will continue to grow. Anat Sci Educ 10: 176–189. © 2016 American Association of Anatomists.     

Can anatomists teach living anatomy using ultrasound as a teaching tool?

The utilization of bedside ultrasound by an increasing number of medical specialties has created the need for more ultrasound exposure and teaching in medical school. Although there is a widespread support for more vertical integration of ultrasound teaching throughout the undergraduate curriculum, little is known about whether the quality of ultrasound teaching differs if performed by anatomists or clinicians. The purpose of this study is to compare medical students' evaluation of ultrasound anatomy teaching by clinicians and anatomists. Hands‐on interactive ultrasound sessions were scheduled as part of the gross anatomy course following principles of adult learning and instructional design. Seven teachers (three anatomists and four clinicians) taught in each session. Before each session, anatomists were trained in ultrasound by clinicians. Students were divided into groups, rotated teachers between sessions, and completed evaluations. Results indicated students perceived the two groups as comparable for all factors except for knowledge organization and the helpfulness of ultrasound for understanding anatomy (P < 0.001). However, results from unpaired samples t‐tests demonstrated a nonstatistically significant difference between the groups within each session for both questions. Moreover, students' test performance for both groups was similar. This study demonstrated that anatomists can teach living anatomy using ultrasound with minimal training as well as clinicians, and encourage the teaching of living anatomy by anatomists in human anatomy courses using ultrasound. Repeating this study at a multicenter level is currently being considered to further validate our conclusion. Anat Sci Educ 7: 340–349. © 2013 American Association of Anatomists.     

Anatomy 3.0: Rediscovering Theatrum Anatomicum in the wake of Covid-19

The Covid-19 pandemic has challenged medical educators internationally to confront the challenges of adapting their present educational activities to a rapidly evolving digital world. In this article, the authors use anatomy education as proxy to reflect on and remap the past, present, and future of medical education in the face of these disruptions. Inspired by the historical Theatrum Anatomicum (Anatomy 1.0), the authors argue replacing current anatomy dissection laboratory (Anatomy 2.0) with a prototype anatomy studio (Anatomy 3.0). In this studio, anatomists are web-performers who not only collaborate with other foundational science educators to devise meaningful and interactive content but who also partner with actors, directors, web-designers, computer engineers, information technologists, and visual artists to master online interactions and processes in order to optimize students' engagement and learning. This anatomy studio also offers students opportunities to create their own online content and thus reposition themselves digitally, a step into developing a new competency of stage presence within medical education. So restructured, Anatomy 3.0 will prepare students with the skills to navigate an emergent era of tele and digital medicine as well as help to foreshadow forthcoming changes in medical education.     

Examining the Short-, Medium-, and Long-Term Success of an Embodied Learning Activity in the Study of Hand Anatomy for Clinical Application

A student's own body provides an often disregarded site of knowledge production and corporeal wisdom. Learning via cognitive processes anchored in physical movement and body awareness, known as embodied learning, may aid students to visualize structures and understand their functions and clinical relevance. Working from an embodied learning perspective, the current article evaluates the use of an offline physical learning tool (Anatomical Glove Learning System; AGLS) for teaching hand anatomy for clinical application in medical students. Two student samples (N₁ = 105; N₂ = 94) used the AGLS in two different ways. In the first sample, the AGLS was compared to a traditional approach using hand bones, models and prosected specimens. Secondly, the AGLS and traditional approach were combined. The evaluation consisted of three outcomes: short-term learning (post-test), medium-term applications (mock-objective structured clinical examination, MOSCE), and longer-term assessment (objective structured clinical examination, OSCE). Findings from the first sample indicated no significant differences between the AGLS and traditional laboratory groups on short- (F_(1,78) = 0.036, P = 0.849), medium- (F_(1,50) = 0.743, P = 0.393), or longer-term (F_(1,82) = 0.997, P = 0.321) outcomes. In the second sample using the AGLS in combination with a traditional approach was associated with significantly better short-term post-test scores (F_(2,174) = 5.98, P = 0.003) than using the AGLS alone, but demonstrated no effect for long-term OSCE scores. These results suggest an embodied learning experience alone does not appear to be advantageous to student learning, but when combined with other methods for studying anatomy there are learning gains.