The Effect of Content Delivery Style on Student Performance in Anatomy

The development of new technologies and ensuing pedagogical research has led many tertiary institutions to integrate and adopt online learning strategies. The authors of this study have incorporated online learning strategies into existing educational practices of a second year anatomy course, resulting in half of the course content delivered via face-to-face lectures, and half delivered online via tailored video vignettes, with accompanying worksheets and activities. The effect of the content delivery mode on student learning was analyzed by tailoring questions to content presented either face-to-face or online. Four practical tests were conducted across the semester with each consisting of four questions. Within each test, two questions were based on content delivered face-to-face, and two questions were based on content delivered online. Examination multiple choice questions were similarly divided and assessed. Findings indicate that student learning is consistent regardless of the mode of content delivery. However, student viewing habits had a significant impact on learning, with students who viewed videos multiple times achieving higher marks than those less engaged with the online content. Student comments also indicated that content delivery mode was not an influence on learning. Therefore student engagement, rather than the mode of content delivery, is a determinant of student learning and performance in human anatomy. Anat Sci Educ. © 2018 American Association of Anatomists.     

Exploring the Dimensions of Medical Student Engagement with Technology-Enhanced Learning Resources and Assessing the Impact on Assessment Outcomes

Anatomy curricula are becoming increasingly populated with blended learning resources, which utilize the increasing availability of educational technology. The educational literature postulates that the use of technology can support students in achieving greater learning outcomes by increasing engagement. This study attempts to investigate the dimensions of student engagement with technology-enhanced learning (TEL) resources as part of a medical program’s anatomy curriculum using exploratory factor analysis. A 25-item five-point Likert-based survey was administered to 192 first-year medical students, with three emergent factors discerned: satisfaction, goal setting and planning, and physical interaction. The three factors closely aligned with the existing literature and therefore additional nonparametric analysis was conducted that explored the levels of engagement across three custom-made anatomy TEL resources, including: (1) anatomy drawing screencasts; (2) an eBook; and (3) a massive open online course (MOOC). Usage data indicated that the most popular resource to be accessed across the cohort was the anatomy drawing screencasts via YouTube, with the MOOC being used least. Moreover, some evidence suggests that those students who utilized the MOOC were more engaged. Generally, however, no correlations were observed between the levels of engagement and TEL resource usage or assessment outcomes. The results from this study provide a clear insight into how students engage with TEL resources, but do not reveal any relationship between levels of engagement, usage, and assessment outcomes.     

The Effects of a Functional Three-dimensional (3D) Printed Knee Joint Simulator in Improving Anatomical Spatial Knowledge

In recent decades, three-dimensional (3D) printing as an emerging technology, has been utilized for imparting human anatomy knowledge. However, most 3D printed models are rigid anatomical replicas that are unable to represent dynamic spatial relationships between different anatomical structures. In this study, the data obtained from a computed tomography (CT) scan of a normal knee joint were used to design and fabricate a functional knee joint simulator for anatomical education. Utility of the 3D printed simulator was evaluated in comparison with traditional didactic learning in first-year medical students (n = 35), so as to understand how the functional 3D simulator could assist in their learning of human anatomy. The outcome measure was a quiz comprising 11 multiple choice questions based on locking and unlocking of the knee joint. Students in the simulation group (mean score = 85.03%, ±SD 10.13%) performed significantly better than those in the didactic learning group, P < 0.05 (mean score = 70.71%, ±SD 15.13%), which was substantiated by large effect size, as shown by a Cohen’s d value of 1.14. In terms of learning outcome, female students who used 3D printed simulators as learning aids achieved greater improvement in their quiz scores as compared to male students in the same group. However, after correcting for the modality of instruction, the sex of the students did not have a significant influence on the learning outcome. This randomized study has demonstrated that the 3D printed simulator is beneficial for anatomical education and can help in enriching students’ learning experience.     

Impact of Background Music on Medical Student Anxiety and Performance During Anatomical Dissections: A Cluster Randomized Interventional Trial

Anatomical dissection on cadavers can be a source of anxiety for medical students. Studies in other stressful settings have shown a reduction in anxiety when there is background music. The objective of this study was to determine if music can have an impact on student anxiety, student satisfaction, and student performance in dissection room. This cluster randomized interventional trial included 187 second-year medical students. The intervention was standardized background music, selected based on the literature, with a tempo of between 60 and 80 bpm. Six balanced clusters were randomized (1:1) to music or no music during dissection sessions. The main assessment criterion was a validated self-evaluation scale score for anxiety, the State Trait Anxiety Inventory. Student satisfaction was measured using a visual analog scale and dissection performance was evaluated by an examination. The outcomes were analyzed with mixed models adjusted on group effect, chronic anxiety, and confounding factors. A significant (58%) relative decrease in acute anxiety, odds ratio 0.423 [0.160; 0.710] was found for the music intervention group. Music also had a positive impact on performance with students in the intervention group attaining higher grades than those in the control group (0.42/10 higher, P = 0.0016). The study also showed a nonsignificant increase in satisfaction with 0.37 extra points (P = 0.137) in the intervention group. Background music had a significant impact on anxiety in the dissection room and on technical and theoretical performance in the subsequent anatomy examination. This music intervention could be extended to other stressful work environments.     

The Effects of Engagement in Inquiry-Oriented Activities on Student Learning and Personal Development

Using data from the College Student Experience Questionnaire research program between 1998 and 2004, this study examined the effects of student engagement in inquiry-oriented activities on a range of self-reported college outcomes. The results indicate that (1) engaging in inquiry-oriented activities has significant and positive effects on a global measure of gains; (2) engagement has positive effects on some college outcomes but negative effects on others; (3) the effects of inquiry-oriented activities are conditional, with some students benefiting more than others. This study reveals the complexity of the influences of inquiry-oriented activities on college students and points to implications for institutional policies and programs that may be effective in fostering desired college outcomes. Shouping Hu  is Associate Professor of Higher Education at Florida State University. He received his M.S. degree in Economics and Ph.D. in Higher Education from Indiana University. His research and scholarship focuses on college access and success, student engagement, and higher education finance. His contact information is 113 Stone Building, Florida State University, Tallahassee, FL 32306. George D. Kuh  is Chancellor’s Professor of Higher Education and Director of the Center for Postsecondary Research at Indiana University Bloomington. He received his Ph.D. degree from the University of Iowa. His research focuses on the quality of undergraduate education. Shaoqing Li  is a senior research analyst in the Office of Institutional Research at Florida A&M University. She received her M.S. degree in Computer Science and Ph.D. in Instructional Systems Technology from Indiana University. Her expertise includes information technologies, learning theories, and institutional research.     

The relationship between student engagement with online content and achievement in a blended learning anatomy course

Blended learning has become increasingly common in higher education. Recent findings suggest that blended learning achieves better student outcomes than traditional face‐to‐face teaching in gross anatomy courses. While face‐to‐face content is perceived as important to learning there is less evidence for the significance of online content in improving student outcomes. Students enrolled in a second‐year anatomy course from the physiotherapy (PT), exercise physiology (EP), and exercise science (ES) programs across two campuses were included (n = 500). A structural equation model was used to evaluate the relationship of prior student ability (represented by grade in prerequisite anatomy course) and final course grade and whether the relationship was mediated by program, campus or engagement with the online elements of the learning management system (LMS; proportion of documents and video segments viewed and number of interactions with discussion forums). PT students obtained higher grades and were more likely to engage with online course materials than EP and ES students. Prerequisite grade made a direct contribution to course final grade (P < 0.001) but was also mediated by engagement with LMS videos and discussion forums (P < 0.001). Student learning outcomes in a blended anatomy course can be predicted the by level of engagement with online content. Anat Sci Educ 11: 471–477. © 2017 American Association of Anatomists.     

Development of a Virtual Three-Dimensional Assessment Scenario for Anatomical Education

In anatomical education three-dimensional (3D) visualization technology allows for active and stereoscopic exploration of anatomy and can easily be adopted into medical curricula along with traditional 3D teaching methods. However, most often knowledge is still assessed with two-dimensional (2D) paper-and-pencil tests. To address the growing misalignment between learning and assessment, this viewpoint commentary highlights the development of a virtual 3D assessment scenario and perspectives from students and teachers on the use of this assessment tool: a 10-minute session of anatomical knowledge assessment with real-time interaction between assessor and examinee, both wearing a HoloLens and sharing the same stereoscopic 3D augmented reality model. Additionally, recommendations for future directions, including implementation, validation, logistic challenges, and cost-effectiveness, are provided. Continued collaboration between developers, researchers, teachers, and students is critical to advancing these processes.     

The Impact of On-campus Student Growth on First-year Student Engagement and Success

During the past two decades institutions of all types have sought to expand and enhance residential facilities. Institutional focus on scale, configuration, amenities, and academic integration has sought to leverage prior research documenting the multiple and often positive impacts of on-campus residence. Although institutional size has been documented to differentially impact student engagement [Kezar, A. J. (2006). NASPA Journal 43(1): 87–114], few studies, however, have directly explored the effect of residential expansion on student engagement. This study, based on a sample of 731 first-time freshmen explores NSSE results before and after the opening of a residential facility that doubled on-campus living at a single, metropolitan institution. Results indicate limited positive differences after opening, and suggest that structure, in the form of size, does not, in and of itself, contribute significantly to shifting engagement. Additionally, these results suggest an alternative method for using NSSE data in institutional analyses.     

Intensive mode delivery of a neuroanatomy unit: Lower final grades but higher student satisfaction

In 2011, Macquarie University moved to a three‐session academic year which included two 13‐week sessions (traditional mode) and one seven‐week session (intensive mode). This study was designed to compare the intensive and traditional modes of delivery in a unit of undergraduate neuroanatomy. The new intensive mode neuroanatomy unit provided the same quantity and quality of material to the same standard, delivered by the same teachers and over the same total hours, but in a shorter timeframe. All students enrolled in session 2 (traditional mode) and session 3 (intensive mode) were invited to participate in this study. The main outcome measures were the final course grades and level of satisfaction with the course. Although there was no significant difference between the two cohorts in self‐rated level of knowledge (P = 0.148), the traditional mode cohort achieved significantly higher final grades compared to the intensive mode cohort (P = 0.001). Similarly, the distribution of final grades was also different between the two cohorts. The two cohorts were equally satisfied with the unit overall, and with the lectures and tutorials. However, the intensive mode cohort was more satisfied with the laboratory practical classes compared to the traditional mode cohort (P < 0.001). Thus this study demonstrates that in the case of neuroanatomy, which is high in content, when the course is taught to the same standards as exist in the traditional mode of delivery, the students do not do as well even though they enjoy the course equally. Anat Sci Educ 6: 286–293. © 2013 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.     

Voice in Digital Education: The Impact of Instructor's Perceived Age and Gender on Student Learning and Evaluation

Instructor evaluations are influenced by implicit age and gender bias, with lower ratings and negative feedback given to instructors believed to stray from stereotypical age and gender norms. Female instructors exhibiting typically male-associated qualities such as leadership and authority, are often negatively impacted. Implicit bias also influences evaluation of digital resources and instructors, regardless of students' positive learning outcomes. As digital learning resources become the norm in education, it is crucial to explore the impact of implicit bias at various educational levels. In this study, undergraduate and graduate students were randomly exposed to one of five digital tutorials; four experimental tutorials presenting identical anatomy content with narrators of different gender and age, and a control tutorial featuring origami (paper folding) instructions without audio. Learning outcomes were measured by pre-quiz vs. post-quiz comparisons using repeated measures MANOVA. Implicit bias was analyzed by evaluation response comparisons using repeated measures MANOVA and three-way MANOVA. Post-quiz scores increased significantly in the four experimental groups (P < 0.05) but not in the control (P = 0.99). The increased performance was not statistically different across the four experimental groups (P > 0.26), suggesting that learning occurred irrespective of the instructor gender and age. Students' evaluations were consistently higher for the experimental resources than the control. There was no significant difference in evaluations across the four experimental groups but compared to the control, younger male and younger female narrators received significantly higher ratings for approachability, acceptance, inclusivity, and care for student learning. The study highlights important considerations for digital resources development and interpretation of student evaluations.     

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.     

Breaking with Tradition: A Scoping Meta-Analysis Analyzing the Effects of Student-Centered Learning and Computer-Aided Instruction on Student Performance in Anatomy

While prior meta-analyses in anatomy education have explored the effects of laboratory pedagogies and histology media on learner performance, the effects of student-centered learning (SCL) and computer-aided instruction (CAI) have not been broadly evaluated. This research sought to answer the question, “How effective are student-centered pedagogies and CAI at increasing student knowledge gains in anatomy compared to traditional didactic approaches?” Relevant studies published within the past 51 years were searched using five databases. Predetermined eligibility criteria were applied to the screening of titles and abstracts to discern their appropriateness for study inclusion. A summary effect size was estimated to determine the effects of SCL and CAI on anatomy performance outcomes. A moderator analysis of study features was also performed. Of the 3,035 records screened, 327 underwent full-text review. Seven studies, which comprised 1,564 participants, were included in the SCL analysis. An additional 19 studies analyzed the effects of CAI in the context of 2,570 participants. Upon comparing SCL to traditional instruction, a small positive effect on learner performance was detected (standardized mean difference (SMD = 0.24; [CI = 0.07, 0.42]; P = 0.006). Likewise, students with CAI exposure moderately outscored those with limited or no access to CAI (SMD = 0.59; [CI = 0.20, 0.98]; P = 0.003). Further analysis of CAI studies identified effects (P ≤ 0.001) for learner population, publication period, interventional approach, and intervention frequency. Overall, learners exposed to SCL and supplemental CAI outperformed their more classically-trained peers as evidenced by increases in short-term knowledge gains. Anat Sci Educ. © 2018 American Association of Anatomists.     

National Survey on Canadian Undergraduate Medical Programs: The Decline of the Anatomical Sciences in Canadian Medical Education

The anatomical sciences have always been regarded as an essential component of medical education. In Canada, the methodology and time dedicated to anatomy teaching are currently unknown. Two surveys were administered to course directors and discipline leaders to gain a comprehensive view of anatomical education in Canadian medical schools. Participants were queried about contact hours (classroom and laboratory), content delivery and assessment methods for gross anatomy, histology, and embryology. Twelve schools responded to both surveys, for an overall response rate of 64%. Overall, Canadian medical students spend 92.8 (± 45.4) hours (mean ± SD) studying gross anatomy, 25.2 (± 21.0) hours for histology, and 7.4 (± 4.3) hours for embryology. Gross anatomy contact hours statistically significantly exceeded those for histology and embryology. Results show that most content is delivered in the first year of medical school, as anatomy is a foundational building block for upper-year courses. Laboratory contact time for gross anatomy was 56.8 (± 30.7) hours, histology was 11.4 (± 16.2) hours, and embryology was 0.25 (± 0.6) hours. Additionally, 42% of programs predominantly used instructor/technician-made prosections, another 33% used a mix of dissection and prosections and 25% have their students complete cadaveric dissections. Teaching is either completely or partially integrated into all Canadian medical curricula. This integration trend in Canada parallels those of other medical schools around the world where programs have begun to decrease contact time in anatomy and increase integration of the anatomical sciences into other courses. Compared to published American data, Canadian schools offer less contact time. The reason for this gap is unknown. Further investigation is required to determine if the amount of anatomical science education within medical school affects students' performance in clerkship, residency and beyond.     

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.     

The Spectrum of Learning and Teaching: The Impact of a Fourth-Year Anatomy Course on Medical Student Knowledge and Confidence

There is growing demand from accrediting agencies for improved basic science integration into fourth-year medical curricula and inculcation of medical students with teaching skills. The objective of this study was to determine the effectiveness of a fourth-year medical school elective course focused on teaching gross anatomy on anatomical knowledge and teaching confidence. Fourth-year medical student “teacher” participants' gross anatomy knowledge was assessed before and after the course. Students rated their overall perceived anatomy knowledge and teaching skills on a scale from 0 (worst) to 10 (best), and responded to specific knowledge and teaching confidence items using a similar scale. First-year students were surveyed to evaluate the effectiveness of the fourth-year student teaching on their learning. Thirty-two students completed the course. The mean anatomy knowledge pretest score and posttest scores were 43.2 (±22.1) and 74.1 (±18.4), respectively (P < 0.001). The mean perceived anatomy knowledge ratings before and after the course were 6.19 (±1.84) and 7.84 (±1.30), respectively (P < 0.0001) and mean perceived teaching skills ratings before and after the course were 7.94 (±1.24) and 8.53 (±0.95), respectively (P = 0.002). Student feedback highlighted five themes which impacted fourth-year teaching assistant effectiveness, including social/cognitive congruence and improved access to learning opportunities. Together these results suggest that integrating fourth-year medical students in anatomy teaching increases their anatomical knowledge and improves measures of perceived confidence in both teaching and anatomy knowledge. The thematic analysis revealed that this initiative has positive benefits for first-year students.     

The Efficacy of Frontline Near-Peer Teaching in a Modern Medical Curriculum

Within medical education a reduction in curriculum time for subjects, such as anatomy puts pressure on educators to ensure the same learning outcomes are conveyed in less time. This has the potential to impact negatively on student experience. Near-peer teaching (NPT) is often praised as an effective revision tool, but its use as a frontline teaching resource remains unreported. The study explores the potential for NPT to promote delivery of learning outcomes and maximize student experience within a neuroanatomy module for second year medical students. The study occurred in three educational settings, (1) frontline NPT of cranial nerves, (2) revision session NPT of cranial nerves, and (3) NPT alongside faculty staff in laboratory-based neuroanatomy practical exercises. For the first and second components, knowledge was measured using a pre- and post-session test and student perception was ascertained with a questionnaire. For the third component, student perception was assessed with an end-of-module survey. The results show that overall, NPT was well received by learners. A significant knowledge gain was seen between the pre- and post-session test of the frontline NPT session. The study presents evidence in favor of using NPTs to supplement the delivery of learning outcomes in a time and resource constrained curriculum. In particular, for the effective delivery of frontline material. Anat Sci Educ 0: 1–9. © 2018 American Association of Anatomists.     

Enhancing Anatomical Instruction: Impact of a Virtual Canine Anatomy Program on Student Outcomes

Innovative reforms in medical education will require instructional tools to support these changes and to give students more flexibility in where and how they learn. At Colorado State University, the software program Virtual Canine Anatomy (VCA) was developed to assist student learning both inside and outside the anatomical laboratory. The program includes interactive anatomical photographs of dissected canine cadavers, dissection instructions with accompanying videos and diagrams, radiographs, and three-dimensional models. There is a need to evaluate the effectiveness of instructional tools like VCA so that decisions on pedagogical delivery can be evidence-based. To measure the impact of VCA on student outcomes in a dissection laboratory, this study compared student attitudes, quiz scores, dissection quality and accuracy, and instructor reliance between students with and without access to VCA. Students with VCA needed less time with teaching assistants (P < 0.01), asked teaching assistants fewer questions (P = 0.04), felt that the dissection was easier (P = 0.02), and were in stronger agreement that they had access to adequate resources (P = 0.02). No differences were found in the dissection quality or accuracy, quiz scores, or attitudes regarding overall enjoyment of the activity between the two groups. This study shows that VCA increases student independence and can be used to enhance anatomical instruction.     

国外学生教学参与的影响因素研究述评及启示

学生参与是实施有效教学的前提,也是学生学业进步和健全人格养成的关键。学生在教学活动中的不参与会阻碍学生的健康成长和课程的顺利实施。因此,近年来,学生参与的影响因素研究成为国外教育工作者们关注的焦点。学生的个人背景,学习环境中的心理体验、教学表征和教育政策都能够影响学生在教学活动中的参与程度。     

The Effect of Passive and Active Education Methods Applied in Repetition Activities on the Retention of Anatomical Knowledge

This study examines the long-term retention of anatomical knowledge from 180 students after various repetition activities. The retention of anatomical knowledge was assessed by multiple-choice tests at five different points in time: before and after a course in Functional Anatomy, before and after repetition activities that occurred 14 weeks after this course, and 28 weeks after this course to establish long-term retention. Students were divided into five groups: one without any repetition activity, one with a restricted repetition activity (the multiple-choice test), and three groups that were offered repetition activities (traditional lecture, e-learning module, and small group work in the dissection room). During all three repetition activities the same information was conveyed, and this content was not revisited in other courses for the duration of the study. The results showed that students who did not engage in a repetition activity scored significantly lower on the long-term retention test compared to all other groups (ANCOVA: P = 0.0001). Pair-wise comparison with estimated means showed that the other four groups, regardless of the type of repeating activity, did not differ in the amount of knowledge they retained during any of the five assessments (P = 0.008, P = 0.0001, P = 0.001, and P = 0.0001, respectively). This study suggests that the type of repetition activity has no effect on knowledge retention both immediately following the activity and in the long term. It is concluded that the repetition of anatomical knowledge in any form is beneficial for students and will likely improve student outcomes in a curriculum that builds on prior knowledge.