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.     

Explicit teaching of meta-strategic knowledge in authentic classroom situations

Meta-strategic Knowledge (MSK) is a sub-component of metacognition that is defined in the present study as general, explicit knowledge about thinking strategies. In the present study we shall focus on the control of variables thinking strategy. Following an earlier study (Zohar & Peled 2007) that showed considerable effects of explicit instruction of MSK in laboratory setting, this study explores whether these effects are preserved in authentic classroom situations. Participants were 119 8th grade students from 6 classes of a heterogeneous school. Equal numbers of low-achieving and high-achieving students were randomly assigned into experimental and control groups. The findings showed dramatic developments in students’ strategic and meta-strategic thinking following instruction. The effect of the treatment was preserved in delayed transfer tests. Our findings show that explicit teaching of MSK had a strong effect on low achieving students. The implications of the findings for learning and instruction are discussed.     

Musculoskeletal anatomy knowledge in Australian chiropractors

Anatomy is a key knowledge area in chiropractic and is formally offered in the undergraduate component of chiropractic education. There is the potential for loss of anatomy knowledge before the opportunity to apply it in a clinical setting. This study aimed to determine whether chiropractic clinicians retain a level of anatomy knowledge comparable to that of chiropractic students and to compare chiropractors' self-rating of their anatomical knowledge against an objective knowledge assessment tool. A previously validated multiple-choice test was utilized to measure retention of limb musculoskeletal (MSK) knowledge in Australian chiropractors. One hundred and one registered chiropractors completed the questionnaire and responses were scored, analyzed, and compared to scores attained by undergraduate and postgraduate chiropractic students who had previously completed the same questionnaire. The results indicated that practitioners retained their anatomy knowledge, with a significantly higher total mean score than the undergraduate group [total mean score = 36.5% (±SD 13.6%); P < 0.01] but not significantly different to the postgraduate group [total mean score = 52.2% (±SD 14.1%); P = 0.74]. There was a weak positive correlation between chiropractors' self-rated knowledge and test performance scores indicating the effectiveness of this Australian chiropractic group in self-assessing their anatomy knowledge. This study found that Australian chiropractors' knowledge of MSK anatomy was retained during the transition from university to clinical practice and they accurately evaluated their own test performance.     

The Nature and Development of Teachers' Metastrategic Knowledge in the Context of Teaching Higher Order Thinking

This study examines the development of teachers' metastrategic knowledge (MSK), a component of metacognitive knowledge, in the context of higher order thinking. Participants were 14 junior high school and high school science teachers who attended a professional development course. Data collection was carried out by triangulation of several data sources: classroom observations, individual interviews, written assignments, and recordings of discussions that took place during the course. The Findings section provides a detailed analysis of the professional development of 2 teachers, as well as an analysis of the development of the 14 teachers as a group. The data provide evidence for the types of knowledge teachers need for applying MSK in the course of instruction, the most specific of which are MSK of thinking skills (that must be explicit) and pedagogical knowledge regarding MSK. The considerable overall development in teachers' MSK following an in-service course consisted of at least 3 different patterns of development: (a) learning MSK regarding new thinking skills, (b) transforming initially implicit metalevel knowledge into explicit metalevel knowledge, and (c) introducing changes in the class culture to value new forms of discourse regarding thinking. The implications for professional development courses in this field are discussed.     

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.     

Impact and educational outcomes of a small group self‐directed teaching strategy in a clinical neuroscience curriculum

The complexity of the material being taught in clinical neuroscience within the medical school curriculum requires creative pedagogies to teach medical students effectively. Many clinical teaching strategies have been developed and are well described to address these challenges. However, only a few have been evaluated to determine their impact on the performance of students studying clinical neuroscience. Interactive, 2‐hour, self‐directed small‐group interactive clinical case‐based learning sessions were conducted weekly for 4 weeks to integrate concepts learned in the corresponding didactic lectures. Students in the small groups analyzed cases of patients suffering from neurological disease that were based on eight learning objectives that allowed them to evaluate neuroanatomical data and clinical findings before presenting their case analysis to the larger group. Students’ performances on the formative quizzes and summative tests were compared to those of first‐year medical students in the previous year for whom the self‐directed, small‐group interactive clinical sessions were not available. There was a significant improvement in the summative performance of first‐year medical students with self‐directed clinical case learning in the second year (Y2) of teaching clinical neuroscience (P < 0.05) when compared with first‐year students in the first year (Y1) for whom the self‐directed learning approach was not available. Student performance in the formative assessments between Y1 and Y2 was not significantly different (P = 0.803). A target of ≥70% student scoring above 80% in the final summative examination was met. The current study revealed evidence for the impact and educational outcomes of a self‐directed, clinical teaching strategy in a clinical neuroscience curriculum for first‐year medical students. Anat Sci Educ 11: 478–487. © 2017 American Association of Anatomists.     

Interactions in vocational education: negotiation of meaning of students and teaching strategies

This study aimed to describe verbal student–teacher interactions in vocational education from a socio-cultural perspective on negotiation of meaning. Teaching as part of these interactions is addressed by a combination of diagnosing, checking and intervening strategies. A study was conducted in which students (n students?=?20) and teacher (n teachers?=?5) from Social Work (SW) and Information and Communication Technology (ICT) worked together in small groups (n groups?=?5) discussing vocational core problems. Each group held five discussions (n discussions?=?25). All discussions were audio recorded and transcribed before they were analysed for negotiation of meaning including teaching strategies. The results showed that 5–8% of the interactions include negotiation of meaning. Interactions in SW groups revealed more negotiation of meaning than in interactions in ICT groups. Teaching strategies mainly included checking and intervening activities in favour of diagnosing activities. Furthermore, teachers used meta-cognitive and conceptual interventions most frequently. The implications of these results are discussed by reflecting on occupational differences and on how negotiation of meaning including teaching strategies can be enhanced.     

Effects of Jigsaw III technique on achievement in written expression

The objective of this paper is to compare the Jigsaw III technique (of cooperative learning) with the instructional teacher-centered teaching method in six graders in terms of the effect of written expression on their academic success. The universe of the study consists of 71 sixth-grade students studying during 2009–2010 academic term in a primary school in the province of Erzurum. Two classes were randomly selected: one (n = 35) of which was the control group where teacher-centered teaching method was applied, the other being experimental group (n = 36) where the Jigsaw III technique was applied. In the study, one of the most common application, pretest/posttest with control group experimental design, was chosen. The data regarding the academic success of the groups were collected by means of the achievement test in Turkish course as pretest, posttest and retention test; the students’ opinions about the group works were obtained through feedback form, group work opinionnaire, and data were analyzed through 11.5 SPSS program. The results of the statistical analysis of teaching a written expression course showed that the experimental group did significantly better than the control group in terms of academic success. In addition, it can be said that the students had positive impressions on the Jigsaw III technique.     

Investigating the Effectiveness of a Constructivist-based Teaching Model on Student Understanding of the Dissolution of Gases in Liquids

The research presented in this paper consisted of an investigation of the effectiveness of a four-step constructivist-based teaching activity on student understanding of how pressure and temperature influence the dissolution of a gas in a liquid. Some 44 Grade 9 students (18 boys and 26 girls) selected purposively from two school classes in the city of Trabzon, Turkey participated in the study. Students’ understanding were evaluated from examination of two items from a purpose-designed solution concept test, face-to-face semi-structured interviews and examination of students’ self-assessment exercises. Statistical analysis using two-way ANOVA of student test scores point to statistically-significant differences in test and total scores (p < 0.05) suggesting that the teaching activities employed help students achieve better conceptual understanding. Further, no statistically significant differences were seen between post-test and delayed test scores, suggesting that teaching the activities enable students to retain their new conceptions in their long-term memory. However, in a few instances the activities resulted in the development of new alternative conceptions, suggesting teachers need to be conscious of the positive and negative effects of any teaching intervention.     

Learning to integrate divergent information sources: the interplay of epistemic cognition and epistemic metacognition

Learning to integrate multiple information sources is vital for advancing learners’ digital literacy. Previous studies have found that learners’ epistemic metacognitive knowledge about the nature of knowledge and knowing is related to their strategic integration performance. The purpose of this study was to understand how these relations come into play as students learn to integrate divergent information sources. To do so, we examined the contribution of scaffolds addressing the epistemic strategy of integration and epistemic metastrategic knowledge about this strategy. Participants were 99 high-achieving Arab Israeli ninth graders. All participants engaged in writing arguments based on divergent information sources. Students in the control condition received no scaffolds; students in the strategic condition received a strategic scaffold; and students in the metastrategic condition received both strategic and metastrategic scaffolds. Integration performance, epistemic metastrategic knowledge about integration, and absolutist, multiplist, and evaluativist epistemic perspectives were measured before, immediately after, and one month after the intervention. At pre-test, both epistemic metastrategic knowledge about integration and evaluativism were positive predictors of integration performance. The strategic scaffold led to a significant increase in integration performance and epistemic metastrategic knowledge. Adding the metastrategic scaffold led to greater improvement in epistemic metastrategic knowledge, but did not result in additional gains in strategic performance. An immediate decrease in absolutism occurred among all participants but was not sustained over time. A decrease in multiplism occurred only in the experimental groups and was sustained over time. The results suggest that epistemic growth can occur in both bottom-up and top-down directions.     

Can the flipped classroom model improve students’ academic performance and training satisfaction in Higher Education instructional media design courses?

While “flipping” a classroom has gained attention in K-12 and Secondary school programs, there has been relatively no explicit focus on its effectiveness as a teaching method for instructional media design courses in Higher Education. The purpose of this quasi-experimental study was to determine the effectiveness of the flipped classroom approach to teaching instructional media design subjects by comparing students’ academic performance and training satisfaction in traditional lecture-based instruction with those in a flipped classroom. A total of 128 undergraduate students participated voluntarily and were divided into a control (n = 62) and an experimental (n = 66) group, respectively. The study findings indicated substantial differences in both academic performance and training satisfaction between the two groups, with the students in the experimental group performing significantly better. Specifically, the results showed some determining factors associated with training satisfaction that explain why students in flipped classes achieved notably higher mastery in the learning objectives than their control group peers. This study adds to the literature by providing evidence on how a flipped classroom can potentially benefit students’ academic performance, leading to higher training satisfaction and deeper disciplinary understanding in instructional media design courses.     

Improvements of self-regulation procedures for fifth graders' reading competence: Analyzing effects on reading comprehension,reading strategy performance,and motivation for reading

In this study, reciprocal teaching (RT) was combined with specific self-regulation procedures to promote the reading comprehension of fifth grade students. Twenty four classes with N = 534 students were assigned to RT plus strategy implementation procedures (RT + SIP), RT plus outcome regulation procedures (RT + ORP), RT plus strategy implementation and outcome regulation procedures (RT + SRL), or RT without explicit instruction in self-regulation. At maintenance students assigned to the three self-regulation conditions outperformed RT students according to a standardized measure of reading comprehension. RT + SIP and RT + SRL students outperformed RT as well as RT + ORP students using a measure of reading strategy performance. However, reading comprehension was only mediated by strategy performance under the RT + SRL condition. Among students assigned to the RT + ORP condition, an improvement in reading motivation between pretest and posttest and between posttest and maintenance was observed.     

The Effect of a Computerized Simulation on Middle School Students’ Understanding of the Kinetic Molecular Theory

The objective of this study was to evaluate the effect of a dynamic software simulation on the understanding of the kinetic molecular theory by 7th graders. Students in the control group (n = 62) studied a curricular unit that addressed the differences in arrangement and motion of molecules in the three phases of matter. The experimental group (n = 71) studied the same unit combined with a few computer lessons using a software simulation. The results indicate that the students in the experimental group scored significantly higher than those in the control group. Nonetheless, while both groups of students improved their understanding of the kinetic molecular theory, the overall achievements were very low. These findings suggest that the simulation improved the understanding of the 7th graders; however, it was insufficient in itself to promote meaningful learning. Statistically significant gender differences were not observed. This paper concludes with a discussion of the educational implications of this study.     

A Three-Dimensional Print Model of the Pterygopalatine Fossa Significantly Enhances the Learning Experience

The pterygopalatine fossa (PPF) is a bilateral space deep within the skull that serves as a major neurovascular junction. However, its small volume and poor accessibility make it a difficult space to comprehend using two-dimensional illustrations and cadaveric dissections. A three-dimensional (3D) printed model of the PPF was developed as a visual and kinesthetic learning tool for completely visualizing the fossa, its boundaries, its communicating channels, and its neurovascular structures. The model was evaluated by analyzing student performance on pre- and post-quizzes and a student satisfaction survey based on the five-point Likert scale. The first cohort comprised of 88 students who had never before studied the PPF. The second cohort consisted of 30 students who were previously taught the PPF. Each cohort was randomly divided into a control group who were provided with a half skull and an intervention group that were provided with the 3D printed model. The intervention group performed significantly better on the post-quiz as compared to the control group in cohort I (P = 0.001); while not significant, it also improved learning in cohort II students (P = 0.124). Satisfaction surveys indicated that the intervention group found the 3D printed model to be significantly more useful (P < 0.05) as compared to the half skull used by the control group. Importantly, the effect sizes for cohorts I and II (0.504 and 0.581, respectively) validated the statistical results. Together, this study highlights the importance of 3D printed models as teaching tools in anatomy education.     

Purposely Teaching for the Promotion of Higher-order Thinking Skills: A Case of Critical Thinking

This longitudinal case-study aimed at examining whether purposely teaching for the promotion of higher order thinking skills enhances students’ critical thinking (CT), within the framework of science education. Within a pre-, post-, and post–post experimental design, high school students, were divided into three research groups. The experimental group (n = 57) consisted of science students who were exposed to teaching strategies designed for enhancing higher order thinking skills. Two other groups: science (n = 41) and non-science majors (n = 79), were taught traditionally, and acted as control. By using critical thinking assessment instruments, we have found that the experimental group showed a statistically significant improvement on critical thinking skills components and disposition towards critical thinking subscales, such as truth-seeking, open-mindedness, self-confidence, and maturity, compared with the control groups. Our findings suggest that if teachers purposely and persistently practice higher order thinking strategies for example, dealing in class with real-world problems, encouraging open-ended class discussions, and fostering inquiry-oriented experiments, there is a good chance for a consequent development of critical thinking capabilities.     

Students' transition into higher education: The role of self-efficacy,regulation strategies,and academic achievements

Transition into higher education (HE) has received increased interest in recent years, since it represents a challenging period for students. The aim of this study was to further understand the associations between self-efficacy, academic achievements, and regulation in first-year university students during their transition into HE. The convenience sample consisted of 374 first-year university students (230 females, 61.5%), aged from 18 to 33 (M = 19.86, SD = 1.51) and recruited from an Italian university. Self-efficacy was assessed using the Motivated Strategies for Learning Questionnaire; regulation strategies were assessed with the Inventory of Learning Patterns of Students; and a self-reported grade point average was taken as an indicator of each student's academic performance. Result shows that students' self-efficacy was positively associated with self-regulation and negatively associated with a lack of regulation. Students with higher self-efficacy and self-regulation strategies had better academic performance. Female students performed better in academic activities and adopted more external regulation strategies. The findings represent an opportunity for university institutions to consider the interventions they provide to first-year students in order to facilitate the successful transition from secondary school; they also provide researchers with further knowledge about the effect of self-efficacy, and regulation strategies on students' adjustment to HE.     

Anatomy Learning from Prosected Cadaveric Specimens Versus Plastic Models: A Comparative Study of Upper Limb Anatomy

Human cadaveric prosections are a traditional, effective, and highly appreciated modality of anatomy learning. Plastic models are an alternative teaching modality, though few studies examine their effectiveness in learning of upper limb musculoskeletal anatomy. The purpose of this study is to investigate which modality is associated with a better outcome, as assessed by students' performance on examinations. Overall, 60 undergraduate medical students without previous knowledge of anatomy participated in the study. Students were assigned into two groups. Group 1 attended lectures and studied from cadaveric prosections (n = 30) and Group 2 attended lectures and used plastic models in the laboratory (n = 30). A knowledge assessment, including examination with tag questions (spot test) and written multiple-choice questions, was held after the end of the study. Students' perceptions were also investigated via an anonymous questionnaire. No significant difference in students' performance was observed between the group using prosections and the group using plastic models (32.2 ± 14.7 vs 35.0 ± 14.8, respectively; P = 0.477). Similarly, no statistically significant difference was found regarding students' satisfaction from using each learning modality (P = 0.441). Plastic models may be a valuable supplementary modality in learning upper limb musculoskeletal anatomy, despite their limitations. Easy to use and with no need for maintaining facilities, they are highly appreciated by students and can be useful when preparing for the use of cadaveric specimens.     

Narrated Dissection Videos and Peer-Mentoring to Enhance Anatomy Performance of Underrepresented Minority Students in Physical Therapy Education

Three-dimensional virtual technology (3DVT) educational tools and peer-tutoring have proven to be effective teaching strategies in improving student learning outcomes. The purpose of this study was threefold: (1) compare the anatomy academic performance between underrepresented minority (URM) and non-minority (non-URM) students, (2) compare the voluntary use of 3DVT dissection videos and peer-mentoring between these two cohorts, and (3) estimate the association between the use of these teaching strategies on anatomy examinations and course grades at a school of physical therapy. Three-dimensional virtual technology narrated dissection videos and peer-mentoring were made available to all students. Time accessing the video and attending peer-mentoring sessions was measured throughout the course for all students. Three practical and four written examinations and the final course grade were calculated. Numerous one-way ANOVAs were used to compare examination/course grades between student cohorts (URM and non-URM) and usage of the two educational strategies (3DVT and peer-mentoring). Multiple linear regressions were performed with teaching strategies as predictors and grades as outcomes. Underrepresented minority students demonstrated significantly lower practical examination scores (P = 0.04), lower final course grades (P = 0.01), and a greater use of mentorship hours (P = 0.001) compared to non-URM. The regression models with both predictors (3DVT and peer-mentoring) combined demonstrated the greatest association with grades for both URM and non-URM. For both groups of students, the association between predictors and practical examination scores, although fair, was not statistically significant. Peer-mentoring seems to be the most effective teaching strategy in helping URM students succeed in anatomy.     

A Hands-On Organ-Slicing Activity to Teach the Cross-Sectional Anatomy

The presentation of pre-sliced specimens is a frequently used method in the laboratory teaching of cross-sectional anatomy. In the present study, a new teaching method based on a hands-on slicing activity was introduced into the teaching of brain, heart, and liver cross-sectional anatomy. A randomized, controlled trial was performed. A total of 182 third-year medical students were randomized into a control group taught with the prosection mode (pre-sliced organ viewing) and an experimental group taught with the dissection mode (hands-on organ slicing). These teaching methods were assessed by testing the students' knowledge of cross-sectional specimens and cross-sectional radiological images, and analyzing students' feedback. Using a specimen test on three organs (brain, heart, and liver), significant differences were observed in the mean scores of the control and experimental groups: for brain 59.6% (±14.2) vs. 70.1% (±15.5), (P < 0.001, Cohen's d = 0.17); for heart: 57.6% (±12.5) vs. 75.6% (±15.3), (P < 0.001, d = 0.30); and for liver: 60.4% (±14.5) vs. 81.7% (±14.2), (P < 0.001, d = 0.46). In a cross-sectional radiological image test, better performance was also found in the experimental group (P < 0.001). The mean scores of the control vs. experimental groups were as follows: for brain imaging 63.9% (±15.1) vs. 71.1% (±16.1); for heart imaging 64.7% (±14.5) vs. 75.2% (±15.5); and for liver imaging 61.1% (±15.5) vs. 81.2% (±14.6), respectively. The effect sizes (Cohen's d) were 0.05, 0.23, and 0.52, respectively. Students in the lower tertile benefited the most from the slicing experiences. Students' feedback was generally positive. Hands-on slicing activity can increase the effectiveness of anatomy teaching and increase students' ability to interpret radiological images.     

Contribution of Meta‐strategic Knowledge to Scientific Inquiry Learning

The aim of the present study is to explore the effects of Meta‐strategic Knowledge (MSK) on scientific inquiry learning. MSK is a subcomponent of metacognition defined as general, explicit knowledge about thinking strategies. Following earlier studies that showed considerable effects of explicit instruction of MSK regarding the strategy of variables control, the present study explores whether similar effects are found in two additional scientific thinking strategies: Define Research Questions and Formulate Research Hypotheses. Participants were 119 eighth‐grade students from six classes of a heterogeneous school. Equal numbers of low‐achieving and high‐achieving students were randomly assigned into experimental and control groups. The findings showed dramatic developments in students’ performance following instruction. The effect of the treatment was preserved in a delayed transfer test. Our findings show that explicit teaching of MSK had a stronger effect for low‐achieving students than for high‐achieving students. The implications of the findings for teaching and learning in the context of scientific inquiry are discussed.