Importance of adequate gross anatomy education: the impact of a structured pelvic anatomy course during gynecology fellowship

Medical education underwent standardization at the turn of the 20th century and remained fairly consistent until recently. Incorporation of a patient-centered or case-based curriculum is believed to reinforce basic science concepts. One negative aspect is a reduction in hours spent with cadaveric dissection in the gross anatomy laboratory. For those entering a surgical career, limited anatomical exposure leaves knowledge deficits that must be corrected during further education during residency training. The benefit of providing formal anatomy education to residents and surgical fellows is described in the literature, specifically noting improvement in written test scores and surgical application.     

Determination of clinically relevant content for a musculoskeletal anatomy curriculum for physical medicine and rehabilitation residents

To address the need for more clinical anatomy training in residency education, many postgraduate programs have implemented structured anatomy courses into their curriculum. Consensus often does not exist on specific content and level of detail of the content that should be included in such curricula. This article describes the use of the Delphi method to identify clinically relevant content to incorporate in a musculoskeletal anatomy curriculum for Physical Medicine and Rehabilitation (PM&R) residents. A two round modified Delphi involving PM&R experts was used to establish the curricular content. The anatomical structures and clinical conditions presented to the expert group were compiled using multiple sources: clinical musculoskeletal anatomy cases from the PM&R residency program at the University of Toronto; consultation with PM&R experts; and textbooks. In each round, experts rated the importance of each curricular item to PM&R residency education using a five‐point Likert scale. Internal consistency (Cronbach's alpha) was used to determine consensus at the end of each round and agreement scores were used as an outcome measure to determine the content to include in the curriculum. The overall internal consistency in both rounds was 0.99. A total of 37 physiatrists from across Canada participated and the overall response rate over two rounds was 97%. The initial curricular list consisted of 361 items. After the second iteration, the list was reduced by 44%. By using a national consensus method we were able to objectively determine the relevant anatomical structures and clinical musculoskeletal conditions important in daily PM&R practice. Anat Sci Educ 7: 135–143. © 2013 American Association of Anatomists.     

Spatial abilities of expert clinical anatomists: comparison of abilities between novices, intermediates, and experts in anatomy

Spatial ability has been found to be a good predictor of success in learning anatomy. However, little research has explored whether spatial ability can be improved through anatomy education and experience. This study had two aims: (1) to determine if spatial ability is a learned or inherent facet in learning anatomy and (2) to ascertain if there is any difference in spatial ability between experts and novices in anatomy. Fifty participants were identified: 10 controls, 10 novices, 10 intermediates, and 20 experts. Participants completed four computerized spatial ability tasks, a visual mental rotation task, categorical spatial judgment task, metric spatial task, and an image-scanning task. The findings revealed that experts (P = 0.007) and intermediates (P = 0.016) were better in the metric spatial task than novices in terms of making more correct spatial judgments. Experts (P = 0.033), intermediates (P = 0.003), and novices (P = 0.004) were better in the categorical spatial task than controls in terms of speed of responses. These results suggest that certain spatial cognitive abilities are especially important and characteristic of work needed in clinical anatomy, and that education and experience contribute to further development of these abilities.     

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.     

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

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

Breaking barriers: The landscape of human and veterinary medical anatomy education and the potential for collaboration

Despite human (HUM) and veterinary (VET) medical institutions sharing the goal of educating future clinicians, there is little collaboration between them regarding curricular and pedagogical practices during the preclinical/basic science training years. This may be, at least in part, due to a lack of understanding of each type of curriculum. This study presents data about curricula, student populations, pedagogical methodologies applied, and anatomy educators' training at both HUM and VET institutions. Preclinical curricula, admissions criteria, and student demographics were analyzed for 21 institutions in the United States having both HUM and VET schools. This dataset was augmented by a questionnaire sent to anatomists internationally, detailing anatomy curricula, pedagogies applied, and anatomy educators' training. Many curricular similarities between both training programs were identified, including anatomy education experiences. However, VET programs were found to include more preclinical coursework than HUM programs. Students who matriculate to VET or HUM schools have similar academic records, including prerequisite coursework and grade point average. Median HUM class size was significantly larger, and the percentage of women enrolled in VET institutions was significantly higher. Training of anatomy educators was identical with one exception: VET educators are far more likely to hold a clinical degree. This study elucidates the substantial similarities between VET and HUM programs, particularly in anatomy education, underscoring the potential for collaboration between both types of programs in areas such as interprofessional education, bioethics, zoonotic disease management, and postgraduate training.     

A novel phased‐concept course for the delivery of anatomy and orthopedics training in medical education

Integration of anatomy and clinical teaching is a theoretical ideal, yet there is a worldwide paucity of such amalgamation. These teaching models provide support for medical trainees, an important element in Germany where orthopedic intern numbers have declined and anecdotal evidence suggests disinterest in orthopedics. The aim of the study was to develop an integrated anatomy‐surgical course for undergraduate medical training, assess the model developed, and explore how medical students perceive orthopedics as a career. The course was to deliver medical anatomy and clinical orthopedic training, focusing on interdisciplinary teaching and learning, vertical integration of clinical knowledge and skills, and professional interaction. Survey evaluation of the course and students' perceptions of orthopedic careers was performed, including Likert‐type responses rating variables of interest. A phased‐concept program of five courses, each optional and under one‐week in duration, was developed parallel to the undergraduate medical program. Delivered by anatomists and surgeons, courses included biomechanics, advanced dissection, surgical approaches, casts and implants, and sports medicine. Course data indicate positive support for course format, stimulation of interest, and high clinical relevance. Students are generally interested in surgery, and identify hierarchy, lawsuits, bureaucracy and physical stress as barriers to orthopedic careers. This novel phased‐concept successfully delivers combined anatomy and surgery training in a vertically‐integrated format while addressing students' clinical and professional skills. The format facilitates an appreciation of potential career options in orthopedics, while fostering professional skills during medical training. Barriers to careers in orthopedics can now be addressed in future courses. Anat Sci Educ 10: 372–382. © 2016 American Association of Anatomists.     

Living AnatoME: Teaching and learning musculoskeletal anatomy through yoga and pilates

Living AnatoME, a program designed in 2004 by two medical students in conjunction with the Director of Anatomy, teaches musculoskeletal anatomy through yoga and Pilates. Previously offered as an adjunct to the Gross Anatomy course in 2007, Living AnatoME became an official part of the curriculum. Previous research conducted on the program demonstrated its efficacy in providing relaxation and well-being to students who attended. In 2007, with all 144 gross anatomy students required to participate in a 1.5 hour Living AnatoME session on the upper and lower limbs, the impact of the program on students' comprehension of musculoskeletal anatomy was analyzed through the administration of 25-question pre- and post-tests, gauging knowledge in the following domains: upper limb, lower limb, muscle function, palpation, attachment/location, clinical correlate, and control (i.e., material not emphasized during the intervention). Analysis of postintervention tests revealed significant improvement in total Living AnatoME scores as well as in the domains of upper limb, muscle function, and palpation, indicating the possible efficacy of Living AnatoME in teaching anatomy. Performance on control questions also improved, although not significantly, which may indicate the role of other variables (e.g., additional study time) in increased performance.     

Spatial abilities and anatomy knowledge assessment: A systematic review

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

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.     

Postgraduate fellows as teaching assistants in human anatomy: an experimental teaching model at a Chinese research university

Postgraduate fellowship training programs are expanding at Chinese universities. This growing cadre of advanced trainees calls for the development of new learning and training models wherein postgraduate fellows have an ample opportunity to teach more junior learners, thereby expanding their own knowledge base and competitiveness for future employment. Educational reform at Sun Yat-Sen University has recently allowed postgraduate fellows to act as teaching assistants for undergraduate anatomy courses. This model is common in western countries but is novel in China.     

Resident perceptions of anatomy education: a survey of medical school alumni from two different anatomy curricula and multiple medical specialties

In 2004, the University of Michigan Medical School reduced its gross anatomy curriculum. To determine the effect of this reduction on resident perceptions of their clinical preparedness, we surveyed alumni that included residents from the original and new shortened curricula. A Likert-scale survey was sent to four classes of alumni. Respondents were compared in old curriculum (OC) and new curriculum (NC) groups, surgical specialty (SS) and nonsurgical specialty (NS) groups, and subgroups of SS and NS were compared for differences between OC and NC. Mean response scores were compared using independent samples T-tests. As a single population (n = 110), respondents felt their anatomy education prepared them well for residency, that a more robust anatomy curriculum would be helpful, that dissection was important to their residency preparation, and that a 4th year anatomy elective was effective in expanding their anatomy education and preparing them for residency. No significant difference existed between OC and NC groups, neither as a whole nor as SS and NS subgroups. The SS group felt dissection was more important to their residency preparation than the NS group (P = 0.001) and that a more robust anatomy curriculum would have better prepared them for residency (P = 0.001). Thirty percent of SS respondents who did not take a 4th year elective commented that they wish they had. Fourth year anatomy electives were highly valued by residents, and respondents felt that they should be offered to students as a way of revisiting anatomy following the 1st year of clinical training.     

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

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

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

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

An eight‐year study of online lecture use in a medical gross anatomy and embryology course

Online lectures have been used in lieu of live lectures in our gross anatomy and embryology course for the past eight years. We examined patterns of online lecture use by our students and related that use to academic entry measures, gender and examination performance. Detailed access records identified by student were available from server logs. Total views per page of lecture material increased over the first six years, then decreased markedly between years seven and eight, possibly due to the recent availability of alternate forms of lecture audio. Lecture use peaked in midafternoon and again in the evening, although some use was seen at all hours. Usage was highest at midweek and lowest on Fridays as might be expected. Individual student's use varied widely from rates equivalent to less than one viewing/page to more than three viewings per page. Overall use by male students was greater than that of females and gender‐specific differences in the daily pattern were seen. Lecture use was correlated to the Medical College Admission Test® (MCAT®) Verbal Reasoning and Physical Sciences scores but not to composite MCAT scores or undergraduate grade point average. Overall use appeared to be driven by scheduled team‐based learning (TBL) sessions and major examinations. Specific subsets of lecture material were most often viewed before related TBL sessions and again during review for examinations. A small but significant correlation between lecture use and examination and course performance was seen, specifically in the male student population. These findings, along with earlier observations, suggest that varied use of online lectures is attributable to multiple factors. Anat Sci Educ © 2012 American Association of Anatomists.     

Analysis of a multifaceted interactive pedagogy program in an upper limb anatomy course: A time series study

Many new methods have contributed to the learning of anatomy, including several interactive methods, increasing the effectiveness of educational programs. The effectiveness of an educational program involving several interactive learning methods such as problem-based learning and reciprocal peer teaching was researched in this study. A quasi-experimental before–after study on three consecutive groups of second-year students at the Grenoble School of Medicine was conducted. The lectures were replaced by an educational program based on the problem-based learning method and reciprocal peer teaching. The first session was dedicated to reading clinical cases illustrating the medical concept, so that the learning objectives for the second session could be set. Then, after viewing digital courses, the second session was dedicated to a synthetic presentation by the students themselves, followed by an interactive summary with the teacher. The analysis of 630 students showed a significant increase in the theory test results for those who took part in the intervention: 9.71 versus 9.19 (β = 0.57, P = 0.036). Moreover, satisfaction was high after the intervention (mean = 4.5/5), and when comparing the two pedagogical approaches the students showed a clear preference for the program implemented with the concepts highlighted such as interactivity, in-depth work, group work, and autonomy. A multifaceted interactive pedagogy program could have a significant impact on the results of the theoretical concepts presented and on satisfaction as well as increased investment by students in learning anatomy.     

Changes in anatomy instruction and USMLE performance: Empirical evidence on the absence of a relationship

Anatomy instruction has evolved over the past two decades as many medical schools have undergone various types of curricular reform. To provide empirical evidence about whether or not curricular changes impact the acquisition and retention of anatomy knowledge, this study investigated the effect of variation in gross anatomy course hours, curricular approach (stand‐alone versus integrated), and laboratory experience (dissection versus dissection and prosection) on USMLE Steps 1 and 2 Clinical Knowledge (CK) scores. Gross anatomy course directors at 54 United States schools provided information about their gross anatomy courses via an online survey (response rate of 42%). Survey responses were matched with USMLE scores for 6,411 examinees entering LCME‐accredited schools in 2007 and taking Step 1 for the first time in 2009. Regression analyses were conducted to examine relationships between gross anatomy instructional characteristics and USMLE performance. Step 1 total scores, Step 1 gross anatomy sub‐scores, and Step 2 CK scores were unrelated to instructional hours, controlling for MCAT scores. Examinees from schools with integrated curricula scored slightly lower on Steps 1 and 2 CK than those from stand‐alone courses (effect sizes of 2.1 and 1.9 on score scales with SDs of 22 and 20, respectively). Examinees with dissection and prosection experience performed slightly better on Step 2 CK than examinees in courses with dissection only laboratories (effect size of 1.2). Results suggest variation in course hours is unrelated to performance on Steps 1 and 2 CK. Although differences were observed in relation to curricular approach and laboratory experience, effect sizes were small. Anat Sci Educ 6: 3–10. © 2012 American Association of Anatomists.     

School autonomy,accountability and collaboration: a critical review

English education has recently experienced radical policy reform in the areas of school autonomy and accountability. The key focus of this paper is on how schools might best navigate through these policy moves. It highlights how these moves have constructed schools, teachers and students in problematic ways but also how they are offering possibilities for improving the quality of schools and schooling. The focus here is on the promise and scope of school collaboration. The difficulties of creating socially responsive and responsible collaboratives in the current ‘heterarchical’ and market-oriented policy environment are acknowledged. Guided by quality democratic governance, they are, nonetheless, presented as crucial in supporting schools to productively deal with the demands of this environment.     

Reflections as near‐peer facilitators of an inquiry project for undergraduate anatomy: Successes and challenges from a term of trial‐and‐error

Near‐peer facilitators (senior students serving as facilitators to their more junior peers) bring a unique student‐based perspective to teaching. With fewer years of teaching experience however, students who become involved in a facilitator role typically develop related skills quickly through a process of trial‐and‐error within the classroom. The aim of this paper is to report on the authors' own experiences and reflections as student near‐peer facilitators for an inquiry‐based project in an undergraduate anatomy course. Three areas of the facilitator experience are explored: (1) offering adequate guidance as facilitators of inquiry, (2) motivating students to engage in the inquiry process, and (3) fostering creativity in learning. A practical framework for providing guidance to students is discussed which offers facilitators a scaffold for asking questions and assisting students through the inquiry process. Considerations for stimulating intrinsic motivations toward inquiry learning are made, paying attention to ways in which facilitators might influence feelings of motivation towards learning. Also, the role of creativity in inquiry learning is explored by highlighting the actions facilitators can take to foster a creative learning environment. Finally, recommendations are made for the development of formalized training programs that aid near‐peer facilitators in the acquisition of facilitation skills before entering into a process of trial‐and‐error within the classroom. Anat Sci Educ. 7: 64–70. © 2013 American Association of Anatomists.