Anatomy as the backbone of an integrated first year medical curriculum: design and implementation

Morehouse School of Medicine chose to restructure its first year medical curriculum in 2005. The anatomy faculty had prior experience in integrating courses, stemming from the successful integration of individual anatomical sciences courses into a single course called Human Morphology. The integration process was expanded to include the other first year basic science courses (Biochemistry, Physiology, and Neurobiology) as we progressed toward an integrated curriculum. A team, consisting of the course directors, a curriculum coordinator, and the Associate Dean for Educational and Faculty Affairs, was assembled to build the new curriculum. For the initial phase, the original course titles were retained but the lecture order was reorganized around the Human Morphology topic sequence. The material from all four courses was organized into four sequential units. Other curricular changes included placing laboratories and lectures more consistently in the daily routine, reducing lecture time from 120 to 90 minute blocks, eliminating unnecessary duplication of content, and increasing the amount of independent study time. Examinations were constructed to include questions from all courses on a single test, reducing the number of examination days in each block from three to one. The entire restructuring process took two years to complete, and the revised curriculum was implemented for the students entering in 2007. The outcomes of the restructured curriculum include a reduction in the number of contact hours by 28%, higher or equivalent subject examination average scores, enhanced student satisfaction, and a first year curriculum team better prepared to move forward with future integration.     

Singapore's anatomical future: Quo Vadis?

The disciplines of anatomy and surgery are not dichotomous since one is dependent on the other. Traditionally, surgeons predominantly taught gross and clinical anatomy. In this review, we examine the context of how human anatomy is taught nowadays. In essence, we discovered that there are certain discernable trends consistently observable between the American and British systems. In Singapore, the British Russell Group first influenced its education landscape but now more so by the American Ivy League. Singapore now has three medical schools all offering differing anatomy curricula, which serves as an opportune time for it to consider if there is a best approach given that the practice of surgery is also evolving in parallel. This review discusses the various pedagogies and issues involved, and will serve as a forum and stimulus for discussion. By tweaking the curriculum correctly and the lessons learnt, future doctors and surgeons in training will receive a better anatomical education, not just in Singapore but the world in general. Key recommendations include the use of body painting, clay, plasticine to facilitate the learning of anatomy, and the implementation of a body donation program. Furthermore, strategic mergers with key stakeholders will also ensure the survival of the discipline.     

Anatomical Sciences Education Vol. 5, Issue 4, 2012 Cover Image

A group of first year medical students at the Yong Loo Lin School of Medicine of the National University of Singapore study anatomy in the Anatomy Museum at this institution. Using an anatomical model, students discuss the extraocular muscles with their lecturers Drs. Boon‐Huat Bay (center) and Eng‐Tat Ang (third from left). In this issue of ASE, Dr. Ang and his colleagues review the past, present, and future of anatomy education in Singapore's three medical schools.     

How does Donor Dissection Influence Medical Students' Perceptions of Ethics? A Cross-Sectional and Longitudinal Qualitative Study

The contribution of donor dissection to modern anatomy pedagogy remains debated. While short-term anatomy knowledge gains from dissection are questionable, studies suggest that donor dissection may have other impacts on students including influencing medical students' professional development, though evidence for such is limited. To improve the understanding of how anatomy education influences medical student professional development, the cross-sectional and longitudinal impacts of donor dissection on medical students' perceptions of ethics were explored. A cross-sectional and longitudinal qualitative study was undertaken at an Australian university where student responses to online discussion forums and in-person interviews were analyzed. Data were collected across the 1.5 years that undergraduate medical students received anatomy instruction (three semesters during first and second years). A total of 207 students participated in the online discussion forums, yielding 51,024 words; 24 students participated in at least 1 of 11 interviews, yielding over 11 hours of interview data. Framework analysis identified five themes related to ethics in an anatomical education context: (1) Dignity, (2) Beneficence, (3) Consent, (4) Justification for versus the necessity of dissection, and (5) Dichotomy of objectification and personification. The dominant themes of students' ethical perceptions changed with time, with a shift from focusing on donors as people, toward the utility of donors in anatomy education. Additionally, themes varied by student demographics including gender, ancestry, and religiosity. Together this study suggests a strong impact of donor dissection on priming students' focus on medical ethics and provides further advocacy for formal and purposeful integration of medical ethics with anatomy education.     

Design,implementation, and evaluation of an innovative anatomy course

Starting in 2004, a medical school gross anatomy course faced with a 30% cut in hours went through an extensive redesign, which transformed a traditional dissection course into a course with a clinical focus, learning societies, and extensive on‐line learning support. Built into the redesign process was an extensive and ongoing assessment process, which included student focus groups, faculty development, surveys, and examinations. These assessments were used formatively, to enhance the course from year to year, and summatively, to determine how well the course was meeting the new learning objectives. The assessments from focus groups and faculty development prompted changes in support structures provided to students and the training and preparation of faculty. Survey results showed that, after student satisfaction declined the first year, satisfaction increased steadily through the fourth iteration as the course gained acceptance by students and faculty alike. There was a corresponding increase in the performance of students on course examinations. An additional examination given to students one and a half and three years after their anatomy course ended demonstrated the redesigned course's long‐term effectiveness for retaining anatomical knowledge and applying it to clinical cases. Compared to students who took the original course, students who took the shorter, more clinical course performed as well, or better, on each section of the examination. We attribute these positive results to the innovative course design and to the changes made based on our formative assessment program. Anat Sci Educ, 2010. © 2010 American Association of Anatomists.     

The question of dissection in medical training: Not just “if,” but “when”? A student perspective

While debate about the use of—and alternatives to—human cadaveric dissection in medical training is robust, little attention has been paid to questions about timing. This study explores the perspectives of medical students and recent graduates with regard to two key questions: when in the degree program do students prefer dissection opportunities and what are the students getting out of participating in dissection? Self-report survey data from students in preclinical years (n = 105), clinical years (n = 57), and graduates (n = 13) were analyzed. Most (89%) preferred dissection during the preclinical years, with no effect by training year (χ² = 1.98, p = 0.16), previous anatomy (χ² = 3.64, p = 0.31), or dissection (χ² = 3.84, p = 0.26) experience. Three key findings emerged. First, the majority of students prefer to dissect in the preclinical years because they view dissection as important for developing foundation knowledge and delivering an opportunity for consolidation prior to transitioning to primarily clinical studies. In addition, students recognize that it is a time-consuming activity requiring specialized facilities. Second, three main understandings of the purpose of dissection were reported: depth of learning, learning experience, and real-world equivalence. Third, these student perspectives of the purpose of dissection are associated with timing preferences for dissection opportunities. The results identify the preclinical phase as the optimal time to strategically integrate dissection into medical training in order to maximize the benefits of this unique learning opportunity for students and minimize its impact upon curricular time.     

Musculoskeletal Radiology Teaching at a UK Medical School: Do We Need to Improve?

The United Kingdom is currently facing crisis due to a shortage of radiology consultants despite ever-increasing demand for medical imaging. The specifics of how best to teach radiology has generated increasing interest. This study aims to determine whether musculoskeletal (MSK) radiology teaching at the University of Nottingham (UoN) Medical School is perceived to be satisfactory by medical students, Foundation-Year doctors, and senior medical professionals in preparing students for the demands working as Foundation-Year doctors. Questionnaires were distributed to all medical students and Foundation-Year doctors that graduated from UoN (n = 307). Semi-structured interviews were conducted with consultants and teaching staff (n = 13). Forty-nine percent of preclinical medical students, 43% of clinical students and 27% of Foundation-Year doctors thought MSK radiology teaching was not sufficient in preparing them for the radiology challenges Foundation-Year doctors' face. This difference was statistically significant (P < 0.001). The consensus from senior medical professionals was that MSK Radiology teaching is currently adequate and producing competent students. Interestingly, only 5% of students were considering a career in radiology compared to 34% of Foundation-Year doctors. Overall, there seems to be concern among students regarding MSK radiology teaching and students have a lack of confidence with MSK radiology. Foundation-Year doctors and senior medical professionals do not share this view. This may be due to medical students' lack of clarity on what is required of them. Formal documentation of set learning objectives for MSK radiology throughout the curriculum may address this.     

Does an Audiovisual Dissection Manual Improve Medical Students' Learning in the Gross Anatomy Dissection Course?

The gross anatomy dissection course is considered to be one of the most important subjects in medical school. Advancing technology facilitates the production of e-learning material that can improve the learning of topographic anatomy during the course. The purpose of this study was to examine a locally produced audiovisual dissection manual's effects on performance in dissection, formal knowledge gained, motivation, emotions, learning behavior, and learning efficiency of the medical students. The results, combined with the total effort put into the production of the manual, should support decisions on further implementation of this kind of audiovisual e-learning resource into the university's curriculum. First-year medical students (n = 279) were randomly divided into three groups for two weeks within the regular dissection course hours during the dissection of the anterior and posterior triangles of the neck. Two groups received an audiovisual dissection manual (n = 96) or an improved written manual (n = 94) as an intervention, the control group (n = 89) received the standard dissection manual. After dissection, each student filled out tests and surveys and their dissections were evaluated. The audiovisual dissection manual did not have any significant positive effects on the examined parameters. The effects of the audiovisual dissection manual on the medical students' learning experience, as observed in this study, did not support further curriculum implementation of this kind of e-learning resource. This study can serve as an orientation for further evaluation and design of e-learning resources for the gross anatomy dissection course.     

Development of a didactical training concept for peer tutors in gross anatomy

Even though peer tutors are often used in gross anatomy courses, research in the field is rather a subject of the last two decades. This is especially true about the didactical challenges these types of peer tutors experience during their tutorials and about how they are prepared for the task. The aim of the presented study was to learn about the training needs of the tutors, and to subsequently design, implement, and evaluate a didactical training concept. A qualitative design was chosen to examine how tutors can best be prepared for tutorials of gross anatomy. To do so, focus group interviews were conducted. The data were analyzed and grouped into various concepts, using semi‐structured interview questions as guidance. It was found that peer tutors are in need of training in the following aspects: Dealing with students who are experiencing difficulties during or as a result of dissection, dealing with group dynamics, that is, at the dissection table, keeping students motivated, time management, and staying confident as a tutor. In order to be regarded as useful and relevant in the eyes of tutors, a preparatory training course should include all these aspects in addition to general didactical training elements. Training needs of peer tutors of gross anatomy go beyond the content of standardized didactical curricula; therefore, tutors should be prepared with a curriculum that is specifically geared toward the many challenges associated with teaching gross anatomy to first year medical students which are already so well documented in the research literature. Anat Sci Educ 10: 495–502. © 2017 American Association of Anatomists.     

Anatomy education in a changing medical curriculum in India: Medical student feedback on duration and emphasis of gross anatomy teaching

Authors report here a survey of medical student feedback on the effectiveness of two different anatomy curricula at Christian Medical College, Vellore, India. Undergraduate medical students seeking the Bachelor in Medicine and Bachelor in Surgery (M.B.B.S.) degrees were divided into two groups by the duration of their respective anatomy curriculum. Group 1 students had completed a longer, 18‐month curriculum whereas Group 2 counterparts followed a shorter, 12‐month curriculum. Students' responses to a questionnaire were studied. Analysis of feedback from Groups 1 and 2 contrasted the effectiveness of the two anatomy curricula. The coverage of gross anatomy was rated adequate or more than adequate by 98% of Group 1 and 91% of Group 2. A desire for greater emphasis on gross anatomy teaching was expressed by 24% of Group 1 and 50% of Group 2 (P = 0.000). Two‐thirds of all students felt that the one‐year program was not adequate, and 90% of Group 1 and 74% of Group 2 felt that clinically oriented anatomy teaching required more emphasis. Dissection was helpful or very helpful for 94% of Group 1 and 88% of Group 2. This study suggests that a better understanding of gross anatomy was gained from a course of longer duration (18 months with 915 contact hr vs. 12 months with 671 contact hr). Students who completed the longer anatomy course had greater appreciation of the need for clinically oriented anatomy teaching and dissection. Anat Sci Educ 2:179–183, 2009. © 2009 American Association of Anatomists.     

Effectiveness of a shortened, clinically engaged anatomy course for physician assistant students

There is little consensus among programs that train physician assistants (PAs) regarding how much time should be devoted to the study of anatomy, what should be included, or how it should be taught. Similar concerns led us to redesign anatomy for medical students and introduce clinically engaged anatomy, an approach designed in collaboration with clinical faculty. This approach presents anatomy entirely within the context of common clinical cases. This report examines whether clinically engaged anatomy could be adapted to the PA program, where students cover the basic sciences in half the time as medical students. We offered a modified version of clinically engaged anatomy to PA students in which time spent in self-directed learning activities was reduced relative to medical students. We compared their scores on an examination of long-term recall to students who took the previous course. Two classes who took clinically engaged anatomy, scored the same or significantly higher on every portion of the examination (P < 0.05). Students expressed high satisfaction with the course (Likert scale, 4.3-4.8/5 points). Compared to medical students who took clinically engaged anatomy, the data suggest that the tradeoff for reducing the time spent in self-directed learning was reduced skills in applying structure-function relationships and spatial reasoning to clinical problems. The data suggest clinically engaged anatomy can be effective in various educational settings, and can be readily adapted to clinical programs that vary in the depth that anatomy is covered. Nonetheless, careful assessments are needed to determine if the necessary tradeoffs are consistent with the goals of the profession.